Successes and failures of the teachable moment

Abstract

Objective We utilized the amyloid imaging ligand Pittsburgh Compound B (PiB) to determine the presence of Alzheimer's disease (AD) pathology in different mild cognitive impairment (MCI) subtypes and to relate increased PiB binding to other markers of early AD and longitudinal outcome. Methods Twenty‐six patients with MCI (13 single‐domain amnestic‐MCI [a‐MCI], 6 multidomain a‐MCI, and 7 nonamnestic MCI) underwent PiB imaging. Twenty‐three had clinical follow‐up (21.2 ± 16.0 [standard deviation] months) subsequent to their PiB scan. Results Using cutoffs established from a control cohort, we found that 14 (54%) patients had increased levels of PiB retention and were considered “amyloid‐positive.” All subtypes were associated with a significant proportion of amyloid‐positive patients (6/13 single‐domain a‐MCI, 5/6 multidomain a‐MCI, 3/7 nonamnestic MCI). There were no obvious differences in the distribution of PiB retention in the nonamnestic MCI group. Predictors of conversion to clinical AD in a‐MCI, including poorer episodic memory, and medial temporal atrophy, were found in the amyloid‐positive relative to amyloid‐negative a‐MCI patients. Longitudinal follow‐up demonstrated 5 of 13 amyloid‐positive patients, but 0 of 10 amyloid‐negative patients, converted to clinical AD. Further, 3 of 10 amyloid‐negative patients “reverted to normal.” Interpretation These data support the notion that amyloid‐positive patients are likely to have early AD, and that the use of amyloid imaging may have an important role in determining which patients are likely to benefit from disease‐specific therapies. In addition, our data are consistent with longitudinal studies that suggest a significant percentage of all MCI subtypes will develop AD. Ann Neurol 2009;65:557–568

Introducing a new stop smoking service in an acute UK hospital: A qualitative study to evaluate service user experience

“…major surgery is a strong motivator; however other authors argue that teachable opportunities are often missed altogether, for example on diagnosis of cancer, stroke or peripheral vascular disease (Mukherjee et al, 2002;Gritz et al, 2005;Croquelois and Bogousslavsky, 2006). A major health benefit occurs whenever patients stop smoking so there is still value in stopping even after a serious smoking-related disease has been identified (Gritz et al, 2005). This supports the need for stop smoking services in acute hospitals and the importance of identifying all patients who are ready to quit smoking.…”

“…In spite of this sense of stigma they were still smoking, so clinical staff need to be sensitive to the broader contexts in patients' lives that impact on their smoking behaviour and the stage of change a person has reached (Zimmerman et al, 2000;Graham, 2007). As Gritz et al (2005) explain for example, cancer patients may be psychologically vulnerable at this time and sensitive to any perceived blame for their condition. Indeed, this study found that a non-blaming, non-judgemental approach from the stop smoking staff was important if they wanted their message to be heard and accepted by smokers.…”

“…Indeed, this study found that a non-blaming, non-judgemental approach from the stop smoking staff was important if they wanted their message to be heard and accepted by smokers. Gritz et al (2005) suggest that advice should focus on the role of addiction, the potential for help by family, friends and healthcare professionals and the negative role of continued smoking on the effectiveness of treatment (Gritz et al, 2005). Their recommendation is for intensive, multimodal intervention (Gritz et al, 2005).…”

“…Gritz et al (2005) suggest that advice should focus on the role of addiction, the potential for help by family, friends and healthcare professionals and the negative role of continued smoking on the effectiveness of treatment (Gritz et al, 2005). Their recommendation is for intensive, multimodal intervention (Gritz et al, 2005). Ultimately the smoker has to develop a non-smoking identity if they are to maintain their quit in the long-term (Carlebach and Hamilton, 2009).…”

“…Rigotti et al (2009) refer to this situation, where the patient is more ready than usual to consider a healthrelated behavioural change, as a 'teachable moment'. However, Gritz et al (2005) conclude from their systematic review that diagnosis of cancer remains an underused opportunity.…”