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Toronto, Canada

Woo K.Y.,Homes for the Aged Inc | Woo K.Y.,West Park Healthcare Center | Woo K.Y.,University of Toronto
Wounds UK | Year: 2010

Pain is a common problem in patients with chronic wounds.This article discusses a systematised approach to address and manage wound-related pain.The impact of psychological factors on pain is often overlooked. Substantial evidence indicates that the more anxiety patients experience from anticipation, the higher their levels of pain during dressing changes.Anxiety as a psychological stress can trigger a cascade of physiological events that impair wound healing. Strategies to allay anxiety must be part of a comprehensive pain treatment plan. Source

Evans R.,West Park Healthcare Center
Canadian respiratory journal : journal of the Canadian Thoracic Society | Year: 2012

The trend of patients who are invasively ventilated to prefer home care is one that benefits both the patient and the health care system. However, this assumes a role for patients' family members to become informal caregivers. To explore the impact of caring for a ventilator-assisted individual on informal caregivers. A descriptive design with semistructured caregiver interviews and the Caregiver Burden Inventory were used. Participants were informal caregivers of a family member with a progressive neuromuscular disease on invasive ventilation for at least six months. Transcript coding was performed and regularly reviewed, and recruitment continued until data saturation. Qualitative analysis was based on 'thematic analysis'. A total of 21 caregivers were interviewed. Five themes developed: a sense of duty; restriction of day-to-day life; physical and emotional burden; training and education; and the need for more paid support. Caregivers described a sense of duty to take care of loved ones, but suffered a significant restriction of their own time with a negative impact on their physical and mental health. The initial transfer home was highlighted as the most stressful part of the process. The Caregiver Burden Inventory scores supported a high level of burden: median 49 (interquartile range 39.5 to 53.0) of a maximum 96. Homecare for ventilator-assisted individuals with progressive neuromuscular disease causes significant burden to informal caregivers. Approaches to lessen this burden, such as increased paid care, improved professional support and respite care, may enable home ventilation to be a more sustainable modality of care. Source

Janaudis-Ferreira T.,West Park Healthcare Center | Janaudis-Ferreira T.,Sunnybrook Research Institute | Beauchamp M.K.,West Park Healthcare Center | Robles P.G.,West Park Healthcare Center | And 3 more authors.
Chest | Year: 2014

Background: The objectives of this systematic review were to synthesize the literature on measures of activities of daily living (ADLs) that have been used in individuals with COPD and to provide an overview of the psychometric properties of the identifi ed measures and describe the relationship of the disease-specifi c instruments with other relevant outcome measures for individuals with COPD and health-care use. Methods: Studies that included a measure of ADLs in individuals with COPD were identifi ed using electronic and hand searches. Two investigators performed the literature search. One investigator reviewed the study title, abstract, and full text of the articles to determine study eligibility and performed the data extraction and tabulation. In cases of uncertainty, a second reviewer was consulted. Results: A total of 679 articles were identifi ed. Of those, 116 met the inclusion criteria. Twentyseven ADLs instruments were identifi ed, of which 11 instruments were respiratory disease-specifi c, whereas 16 were generic. Most instruments combined instrumental ADLs (IADLs) with basic ADLs (BADLs). The majority of the instruments were self-reported; only three instruments were performance based. Twenty-one studies assessed psychometric properties of 16 ADLs instruments in patients with COPD. Conclusions: Although several ADLs instruments were identifi ed, psychometric properties have only been reported in a few. Selection of the most appropriate measure should focus on the target construct (BADLs or IADLs or both), type of test (disease-specifi c vs generic and self-reported vs performance-based), depth of information obtained, and psychometric properties of the instruments. Given the relevance of ADLs to the lives of patients with COPD, its assessment should be more frequently incorporated as a clinical outcome in their management. © 2014 American College of Chest Physicians. Source

Brode S.K.,Sinai University | Brode S.K.,West Park Healthcare Center | Brode S.K.,University of Toronto | Daley C.L.,National Jewish Health | And 3 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2014

SETTING: Tuberculosis (TB) rates are decreasing in many areas, while non-tuberculous mycobacteria (NTM) infection rates are increasing. The relationship between the epidemiology of TB and NTM infections is not well understood.OBJECTIVE: To understand the epidemiologic relationship between TB and NTM disease worldwide.DESIGN: A systematic review of Medline (1946-2014) was conducted to identify studies that reported temporal trends in NTM disease incidence. TB rates for each geographic area included were then retrieved. Linear regression models were fitted to calculate slopes describing changes over time.RESULTS: There were 22 studies reporting trends in rates of NTM disease, representing 16 geographic areas over four continents: 75% of areas had climbing incidence rates, while 12.5% had stable rates and 12.5% had declining rates. Most studies (81%) showed declining TB incidence rates. The proportion of incident mycobacterial disease caused by NTM was shown to be rising in almost every geographic area (94%).CONCLUSION: We found an increase in the proportion of mycobacterial disease caused by NTM in many parts of the world due to a simultaneous reduction in TB and increase in NTM disease. Research into the interaction between mycobacterial infections may help explain this inverse relationship. © 2014 The Union. Source

Woo K.Y.,West Park Healthcare Center
Surgical technology international | Year: 2010

Wound infection is common and delays wound healing. Validated signs included in the mnemonic NERDS and STONEES can be used to identify whether bacterial damage is superficial or deep, respectively. Clinicians must discern when bacterial damage has occurred on a timely basis and what treatment strategies to institute. A variety of topical antimicrobial agents have been developed incorporating iodine, chlorhexidine, silver, honey, topical oxygen, and topical antibiotics. Selection of appropriate strategies should be based on three key factors: healability (healable versus nonhealable), bacterial burden (colonization versus deep infection), and host risk factors. This article reviews and offers succinct recommendations pertaining to the management of wound infection in clinical practice. Source

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