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  • 1
    Online Resource
    Online Resource
    CMA Impact Inc. ; 2017
    In:  Canadian Journal of Surgery Vol. 60, No. 1 ( 2017-02-01), p. 14-18
    In: Canadian Journal of Surgery, CMA Impact Inc., Vol. 60, No. 1 ( 2017-02-01), p. 14-18
    Abstract: Background: Proactive geriatric trauma consultation service (GTCS) models have been associated with better delivery of geriatric care and functional outcomes. Whether such collaborative models can be improved and sustained remains uncertain. We describe the sustainability and process improvements of an inpatient GTCS. Methods: We assessed workflow using interviews and surveys to identify opportunities to optimize the referral process for the GTCS. Sustainability of the service was assessed via a prospective case series (July 2012–December 2013). Study data were derived from a review of the medical record and trauma registry database. Metrics to determine sustainability included volume of cases, staffing levels, rate of adherence to recommendations, geriatric-specific clinical outcomes, trauma quality indicators, consultation requests and discharge destination. Results: Through process changes, we were able to ensure every eligible patient was referred for a comprehensive geriatric assessment. Compared with the implementation phase, volume of assessments increased and recommendation adherence rates were maintained. Delirium and/or dementia were the most common geriatric issue addressed. The rate of adherence to recommendations made by the GTCS team was 88.2%. Only 1.4% of patients were discharged to a nursing home. Conclusion: Workflow assessment is a useful means to optimize the referral process for comprehensive geriatric assessment. Sustainability of a GTCS was shown by volume, staffing and recommendation adherence.
    Type of Medium: Online Resource
    ISSN: 0008-428X
    Language: Unknown
    Publisher: CMA Impact Inc.
    Publication Date: 2017
    detail.hit.zdb_id: 2026595-5
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  • 2
    Online Resource
    Online Resource
    Frontiers Media SA ; 2024
    In:  Frontiers in Cellular Neuroscience Vol. 18 ( 2024-4-19)
    In: Frontiers in Cellular Neuroscience, Frontiers Media SA, Vol. 18 ( 2024-4-19)
    Abstract: The plasticity of inhibitory interneurons (INs) plays an important role in the organization and maintenance of cortical microcircuits. Given the many different IN types, there is an even greater diversity in synapse-type-specific plasticity learning rules at excitatory to excitatory (E→I), I→E, and I→I synapses. I→I synapses play a key disinhibitory role in cortical circuits. Because they typically target other INs, vasoactive intestinal peptide (VIP) INs are often featured in I→I→E disinhibition, which upregulates activity in nearby excitatory neurons. VIP IN dysregulation may thus lead to neuropathologies such as epilepsy. In spite of the important activity regulatory role of VIP INs, their long-term plasticity has not been described. Therefore, we characterized the phenomenology of spike-timing-dependent plasticity (STDP) at inputs and outputs of genetically defined VIP INs. Using a combination of whole-cell recording, 2-photon microscopy, and optogenetics, we explored I→I STDP at layer 2/3 (L2/3) VIP IN outputs onto L5 Martinotti cells (MCs) and basket cells (BCs). We found that VIP IN→MC synapses underwent causal long-term depression (LTD) that was presynaptically expressed. VIP IN→BC connections, however, did not undergo any detectable plasticity. Conversely, using extracellular stimulation, we explored E→I STDP at inputs to VIP INs which revealed long-term potentiation (LTP) for both causal and acausal timings. Taken together, our results demonstrate that VIP INs possess synapse-type-specific learning rules at their inputs and outputs. This suggests the possibility of harnessing VIP IN long-term plasticity to control activity-related neuropathologies such as epilepsy.
    Type of Medium: Online Resource
    ISSN: 1662-5102
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2024
    detail.hit.zdb_id: 2452963-1
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