Entreprendre une carrière universitaire : atelier interactif

Conférencier : Kenneth Rockwood, M.D., FRCPC, FRCP, service de gériatrie, Université Dalhousie, Halifax (Nouvelle-Écosse).

En s’adressant à son auditoire, comme clinicien et universitaire, le D^r Kenneth Rockwood a suggéré que la meilleure paraphrase pour décrire la recherche était tout effort, déployé au sein de la médecine universitaire, visant à « améliorer les soins aux patients ».

L’engagement en médecine et en recherche universitaire
Le D^r Rockwood s’est attaché à brosser un tableau de l’engagement professionnel requis en médecine universitaire. Il a prévenu les aspirants universitaires à quel point ils devront consacrer du temps et de l’énergie à leurs activités universitaires, en plus de leur travail clinique. Cependant, les possibilités sont considérables pour améliorer les soins aux patients, et la médecine gériatrique est une spécialité en demande croissante. Après avoir longtemps été le parent pauvre des spécialités médicales, cette discipline voit ses niveaux de rémunération s’harmoniser de plus en plus avec ceux des autres spécialités.

Le D^r Rockwood a rappelé à son auditoire qu’il existe au sein de la communauté universitaire des filières de recherche et d’enseignement, ainsi que des débouchés pour ceux que le travail administratif intéresse. À ceux qui désirent enseigner, il a suggéré que la formation en gériatrie doit continuer à se traduire par une cohérence du corpus des enseignements, et qu’ils doivent tenter de clarifier les principes directeurs qui sous-tendent les savoirs transmis.

Ce qui distingue la gériatrie : l’approche comparative
Pour illustrer son propos, le D^r Rockwood a discuté de la compétence essentielle au cœur de la spécialité. Il a décrit les géria- tres comme devant être des « maîtres de la complexité ». En pratique, cela se traduit par le fait de devoir penser à plusieurs points simultanément. Selon lui, la gériatrie se distingue non seulement par son étendue et sa complexité (embrassant des facteurs tels que l’évolution fonctionnelle du patient, sa qualité de vie future, les résultats de l’examen psychiatrique, la médecine préventive, etc.), mais aussi par un domaine d’action tout à fait unique à cette spécialité.

La médecine gériatrique est avant tout une sous-spécialité de la médecine interne portant sur des personnes âgées fragiles ayant des problèmes complexes, a déclaré le D^r Rockwood. Les gériatres se distinguent des internistes par le fait qu’ils possèdent une vue d’ensemble de la complexité du tableau de santé du patient. À l’opposé, les autres spécialités ont tendance à isoler les problèmes et à les aborder séparément. L’évaluation gériatrique globale, qui recouvre la complexité due à la fragilité, est la marque de la médecine gériatrique.

Cela pose des défis particuliers et apporte des gratifications uniques, a expliqué le D^r Rockwood. En médecine universitaire, les gériatres doivent s’efforcer de transformer les esprits et les comportements, c’est-à-dire permettre à ceux avec qui ils collaborent de saisir la nature des problèmes. De plus, le caractère très glo- bal de la pratique gériatrique sollicite un travail d’équipe multidisciplinaire. Il est parfois difficile d’atteindre l’objectif final, à savoir prodiguer des soins meilleurs, en raison des conflits entre les disciplines et des problèmes de coordination des savoirs de multiples professionnels.

Transmission des savoirs en gériatrie
Le D^r Rockwood a conseillé aux aspirants à une carrière universitaire de ne pas se contenter d’enseigner des sujets pour lesquels ils ont une passion, mais de transmettre également des enseignements et des principes cohérents qui soient à même de transformer les pratiques. C’est le travail d’un passeur de connaissances : transmettre des concepts de façon à ce qu’ils soient utiles à d’autres. Les gériatres qui enseignent et font de la recherche doivent non seulement proposer un ensemble cohérent de connaissances, mais aussi offrir une formation sur les outils cliniques correspondant aux réalités opératoires de la pratique. Il a également mis l’accent sur le fait que l’enseignement doit être réactif et pouvoir s’adapter à l’auditoire.

Le D^r Rockwood a fait remarquer que les gériatres ne sont pas les seuls professionnels de la santé œuvrant dans des situations complexes porteuses de conséquences graves. Par exemple, l’industrie aéronautique développe des procédures et des outils analytiques utiles à la prise de décisions de vie ou de mort en situations complexes. La gériatrie pourrait tirer des connaissances de certains des modes de pensée, d’analyse et d’action adoptés par cette industrie.

En ce qui concerne le développement et l’utilisation du concept de fragilité et des échelles de fragilité en évolution, il a insisté pour que non seulement les cliniciens tiennent compte de la complexité du travail avec des personnes âgées fragiles, mais qu’ils améliorent également leur capacité à discerner les tableaux cliniques. Le D^r Rockwood a fait remarquer à quel point on se sert de signes cliniques non formels pour corroborer une aggravation de la fragilité, et il a demandé aux personnes de l’assistance d’offrir leurs propres indices déductifs (p. ex. : l’incapacité des patients à changer de points de pression). Il a recommandé à ses auditeurs de prêter attention aux difficultés associées au tableau clinique ty-pique ou atypique des patients âgés, faisant remarquer que la gériatrie devait mieux s’intéresser aux plaintes des patients qui ne se sentent pas bien. L’enseignement en gériatrie doit œuvrer à promouvoir les compétences des praticiens en matière de compréhension des patients, a-t-il suggéré.

Acquérir une formation avancée en gériatrie
Le D^r Rockwood a offert des conseils concrets pour acquérir une formation avancée en gériatrie. Il a vivement préconisé de choisir un mentor, et a offert des conseils pour établir et approfondir ce type de relation (se familiariser avec le travail du mentor, offrir une assistance de recherche). L’avantage pour l’étudiant? Non seulement il approfondit ses connaissances, mais il accède également aux données et au nom du mentor et à sa collaboration pour des publications. En échange, l’étudiant offre son temps, son énergie, son enthousiasme et ses idées, et représente une promesse de prolonger le travail du mentor (Figure 1). Le D^r Rockwood a suggéré aux aspirants universitaires et aux chercheurs de ne pas trop limiter leurs options avec des travaux de recherche restreints à une seule technologie ou technique thérapeutique, et de prendre soin à ce que leur travail contribue à un ensemble de données cliniques et de recherche se consolidant quotidiennement de façon incrémentale.

Au cours du forum de discussion, le D^r Rockwood a répété que la recherche devait incarner les valeurs personnelles du professionnel de la santé. Il a noté que les médecins non universitaires peuvent travailler en association avec des chercheurs et des universitaires. Il a fait observer que de telles relations de travail sont généralement stimulées par une collaboration avec des universitaires, souvent ouverts à ce type d’engagement. Il a également parlé du travail avec des représentants de l’industrie pharmaceutique, en insistant pour que toute personne engagée dans ce type de travail se souvienne qu’il s’agit d’une proposition d’affaires manifeste de la part de l’industrie. Des renseignements de grande valeur peuvent émerger d’un travail soutenu par l’industrie, a-t-il déclaré. De telles participations représentent souvent des occasions de réseautage avec d’autres médecins ou des groupes avec lesquels un clinicien n’entre habituellement pas en contact.

Selon le D^r Rockwood, les apprentis envisageant d’intégrer le monde universitaire ont surtout besoin de temps, d’argent et de soutien. Le temps devant être consacré aux recherches cliniques est la plus grande exigence de la recherche clinique. C’est ici que l’apprenti établit sa bonne foi, en même temps qu’il développe des relations professionnelles essentielles. En outre, l’aspirant chercheur a besoin de fonds pour acquérir et rémunérer un bon assistant de recherche, ainsi que des subventions de recherche. Finalement, le travail requiert le soutien des autres : à savoir, l’accès à des investigateurs confirmés pouvant se révéler des alliés.

Click here to view the entire report from the 28th Annual Scientific Meeting of the Canadian Geriatrics Society

Getting Started in an Academic Career: An Interactive Workshop

Speaker: Kenneth Rockwood MD, FRCPC, FRCP, Division of Geriatric Medicine, Dalhousie University, Halifax, NS.

Addressing his audience as both a clinician and as an academician, Dr. Kenneth Rockwood suggested that the best synonym for research is any effort within academic medicine that serves to “make patient care better.”

The Commitment to Academic Medicine and Research
Dr. Rockwood sought to convey the professional commitment academic medicine requires. He advised that the time and energy that aspiring academicians must commit, in addition to that required for clinical work, is significant. Nonetheless, the opportunities to make a difference in patient care in this arena are significant, and geriatric medicine as a specialty is in growing demand. Compensation levels are increasingly aligning with other specialties after a history of ranking behind.

Dr. Rockwood reminded listeners that within the academic community there are research and teaching tracks, and opportunities for those interested in administrative work. For those hoping to teach, he suggested that instruction in geriatric medicine must continue to result in coherence in the body of the teachings, and that they must contribute to the effort to clarify the guiding principles behind the knowledge conveyed.

The Distinction of Geriatrics: The Comprehensive Approach
To illustrate, Dr. Rockwood discussed the core skill underpinning the specialty. Dr. Rockwood described geriatricians as having to be “masters of complexity.” In practice, this can translate as having to think about several items simultaneously. Geriatric medicine is distinguished, according to Dr. Rockwood, not only by its comprehensiveness and complexity (accounting for factors such as the patient’s functional course, future quality of life, the result of the mental exam, preventive medicine, and more) but also by a domain of action very unique to this subspecialty.

Geriatric medicine is foremost a subspeciality of internal medicine concerned with older frail people who have complex problems, Dr. Rockwood stated. Geriatricians are distinguishable from internists by their embracing of the complexity of the patient’s total health picture. In contrast, the instinct of other specialties is to itemize problems and address them individually. The Comprehensive Geriatric Assessment that embraces complexity due to frailty is the signature of geriatric medicine.

This leads to particular challenges and rewards, explained Dr. Rockwood. In academic medicine, they must work to change people’s minds and behaviours—that is, empower those they collaborate with to understand what the problems are. Further, the comprehensive nature of the practice of geriatrics requires multidisciplinary teamwork. Conflicts between disciplines and problems of coordinating the knowledge of multiple professionals can sometimes compromise meeting the goal of better care.

Knowledge Translation in Geriatrics
Dr. Rockwood advised aspiring academicians to not only teach subjects they are passionate about but to convey coherent teachings and principles that are able to change practices. This is the work of knowledge translation: mediating concepts in a way aimed at helping others. Geriatricians who teach and research must offer not only a coherent body of knowledge, but offer instruction in clinical tools that match what he called the operative realities in practice. He also stressed that teaching must be responsive and its aims changed according to the audience’s needs.
Again addressing the complexity marking geriatric medicine as both a clinical and academic specialty, he noted that geriatricians are not the only professionals dealing in complex situations of grave consequence. The airline industry, for example, is noted for developing procedures and analytic tools that aid life-and-death decision making in complex situations. Geriatric medicine might learn from some of the modes of thinking, analysis, and action that they have adopted.

Regarding the development and use of frailty as a concept and the evolving frailty scales, he urged that clinicians embrace the complexity working with frail older adults presents, but also foster their capacity to discern patterns. Dr. Rockwood noted the preponderant use of informal clinical signs used to corroborate worsening frailty, and asked listeners to offer their own deductive shorthands (e.g., a patient’s incapacity to move off his/her pressure points). He recommended that listeners attend to the difficulties associated with typical versus atypical presentations among older patients, noting that one area where geriatrics must improve is in remaining open to patient pleas of not being well. Geriatrics teaching must work on advancing practitioners’ comprehensible skill sets, he suggested.

Obtaining Advanced Training in Geriatrics
Dr. Rockwood offered concrete tips on obtaining advanced training in geriatric medicine. He strongly recommended aligning with a mentor, and he offered several tips on founding and furthering such relationships (e.g., familiarizing oneself with the mentor’s work, offering research assistance). The value to the student is not only a gain in knowledge but access to the mentor’s data as well as the mentor’s name and collaboration for publications. In exchange, the student offers his/her time, energy, enthusiasm, ideas, and the chance to bring longevity to the mentor’s work (Figure 1). Other specific tips Dr. Rockwood offered to aspiring academicians and researchers included not too narrowly limiting options by tying all of one’s research to a particular technology or treatment technique, and ensuring that one’s work contributes to a body of research and clinical data being fortified on a daily, incremental basis.

In the question forum, Dr. Rockwood reiterated that research should embody one’s values as a health professional. He noted that there is opportunity for nonacademic physicians to do work often associated with formal academics and researchers. Dr. Rockwood observed that such working relationships are usually fostered through collaboration with formal academicians, who are often open to this kind of engagement. Dr. Rockwood also offered observations on working with representatives from the pharmaceutical industry. He advocated that anyone doing this kind of work recall that it is a clear business proposition from the industry’s standpoint. Valuable information can emerge from work supported by industry, Dr. Rockwood suggested. The advantage of such involvements are often the networking opportunities with other physicians and groups that a clinician might not normally come into contact with.

What trainees thinking about entering into academia most require, Dr. Rockwood stated, are time, money, and help. Time spent doing clinical work is the foremost requirement for clinical research. This is where the trainee establishes both his/her bona fides as well as builds essential professional relationships. Further, the aspiring researcher needs funds for acquiring and supporting a good research assistant and research grants. Finally, the work requires the help of others: namely, access to established investigators who may serve as allies.

Peter N. McCracken, MD, FRCPC, Professor of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, AB.
Darryl Rolfson, MD, FRCPC, Assistant Professor of Medicine, Division of Geriatric
Medicine, University of Alberta, Edmonton, AB.

Even within the Canadian health care system, one which strives to be comprehensive, universal, and accessible, disparities exist for Canadians who are unable to access timely clinical and educational support due to distance. Telemedicine, which bridges distances to allow clinical, educational, and administrative interactions, fits this need like a glove. In 2005, the acceptability of the technology now leaves clinicians, health educators, and health care administrators in a position to assist almost without excuse. To be successful, telehealth requires willing participants, sensible application technology, and a dense network of broadband linkages. Although qualitative research is plentiful, high quality quantitative research into telehealth is still only emerging, as evidenced by the example of telehealth applications in educational and clinical geriatrics.

Key words: telemedicine, telehealth, geriatrics, medical education, research.

Durhane Wong-Rieger, PhD, President, Anemia Institute for Research & Education.

Anemia affects tens of thousands of Canadians, including many older people. While some types of anemia are relatively easy to diagnose and treat, complications such as chronic disease or complex medication regimes can often interfere with diagnosis and management of this condition.

The Anemia Institute for Research & Education (AIRE) is the first and only nonprofit organization in the world committed entirely to generating and sharing knowledge about anemia. AIRE supports patients in understanding anemia, its causes, effects and the available treatment options. The Institute partners with numerous patient and professional groups to facilitate patient education on anemia and blood safety and supply. Furthermore, through a yearly research grant competition, AIRE sponsors numerous anemia research studies. All in all, the Anemia Institute is working hard to ensure that anemia is treated seriously.

For Physicians: Anemia Guidelines for Primary Care
In a 2001 survey of family physicians across Canada, 90% of doctors indicated their interest in clinical practice guidelines on anemia for family practice. The Anemia Institute responded, initiating the development of Anemia Guidelines for Primary Care with MUMS Guidelines Clearinghouse (Medication Use Management Services), to be published in May 2003. The Anemia Guidelines is the fifth book in the Orange Book guideline series published by MUMS. This easy to use, peer-reviewed and fully-referenced book provides diagnostic and treatment guidelines for the full range of anemia conditions (see Table 1 for a selection of topics covered).

A limited number of complimentary copies of the Anemia Guidelines is available from AIRE. To order, please visit www.anemiainstitute.org and go to the Healthcare Professionals section.

For Your Patient: Anemia Educational Tools
The Anemia Institute's series of patient leaflets covers the most common types of anemia. Patient Educational Leaflets include:

• What is Anemia?
• What is Hemoglobin?
• Anemia & Nutrition
• Anemia & Iron Deficiency
• Anemia & Cancer
• Anemia & Kidney Disease
• Anemia & Surgery
• Anemia & Hepatitis C
• Anemia & HIV/AIDS
• Anemia & Children and Teens.

Anemia Awareness Week is the Institute's yearly campaign to raise awareness of anemia among the general public. This takes place each year during the last week of March. In March 2003, the public were invited to visit numerous hemoglobin screening clinics and anemia display booths in pharmacies and hospitals across Canada. Similar events are planned for Anemia Awareness Week next year, March 22&endash;26, 2004.

Research & Development Fund
The Anemia Institute Research & Development Fund supports research initiatives through a yearly, peer-reviewed grant competition. Projects currently funded include:

• the role of anemia and red blood cell substitutes in traumatic brain injury;
• new strategies to treat post-transplant anemia;
• anemia among the inner city homeless.

More information on the AIRE research grant process, including funding priorities and application procedures, can be found on the Internet at www.anemia-institute.org.

Paul B. Miller, BA, MA, MPhil, is a JD/PhD candidate in law and philosophy at the University of Toronto, and a Junior Fellow of Massey College in Toronto, Toronto, ON.
Trudo Lemmens, Lic Iur, LLM, is Assistant Professor in the Faculty of Law at the University of Toronto, Toronto, ON.

Lucrative Research
A pharmaceutical company invites Dr. B, a primary care physician, to assist with a placebo-controlled randomized clinical trial (RCT) of a new cholinesterase inhibitor for the treatment of dementia. The study will include patients who have been diagnosed with early-onset dementia. Dr B will receive $3,500 for each patient who ultimately agrees to enrol in the study. In the protocol, this fee is explained as payment of the administrative costs associated with Dr B's participation in the trial (in particular, as payment of "costs of obtaining informed consent, accumulating data, secretarial support, and consultation with each subject").

This hypothetical case illustrates an increasingly common phenomenon--offers of "finder's fees" and other "administrative" fees by pharmaceutical companies or Contract Research Organizations (CROs) to primary care physicians for conducting research involving their patients. Finder's fees are offers of money to physicians in reward for referral of patients eligible for research participation. They can be distinguished from payments made to cover costs of research participation.

Researchers at Yale University have come up with a new take on an old problem: how to cut off blood supply to a tumour. Previously, it was believed that we might be able to eradicate cancer by preventing tumour angiogenesis--a theory that worked well in animal models, but had disappointing results in humans. The new twist on the method developed by Hu and Garen is to destroy tumours by killing the blood vessels that supply them, rather than trying to prevent their development in the first place.

The researchers developed an immunoconjugate molecule (icon), composed of a mutated mouse factor VII (mfVII) targeting domain and the Fc effector domain of an IgG1 Ig (mfVII/Fc icon), and tested its efficacy in mouse models of human and mouse prostate cancer, and human melanoma. Mice were injected subcutaneously with a human prostatic tumour line, forming a skin tumour that produces a high blood titer of prostate-specific antigen and metastasizes to bone. The icon was encoded in a viral vector that was injected directly into the tumour. Tumour cells infected with the vector synthesize more of the icon molecule and secrete it into the blood where it binds to mouse tissue factor expressed on endothelial cells lining the lumen of the tumour vasculature and to human tissue factor on the tumour cells. One part of the icon then activates an immune attack against any cell that is capable of binding it--which means that the immune attack is only directed against cells that show 'tumour' characteristics. Injection with icon resulted in long-term regression of the injected human prostatic tumour, and also of the uninjected tumour (a model for a metastasis), without any toxicity to the mouse. The same results were obtained for the mouse model of human melanoma.

The researchers are hoping to begin clinical trials in humans next spring, although they caution that it is far too early to predict how well the technique will work in humans.

Source

1. Hu Z and Garen A. Targeting tissue factor on tumor vascular endothelial cells and tumor cells for immunotherapy in mouse models of prostatic cancer. Proc. Natl. Acad. Sci. USA, 10.1073/pnas.201420298.

Michael Gordon, MD, MSc, FRCPC
Vice President of Medical Services,
Baycrest Centre for Geriatric Care,
Professor of Medicine,
University of Toronto,
Toronto, ON.

The husband looked to his wife when he was asked if he would allow me to refer him to participate in a research trial. He admitted that he had some "memory" problems but was not really aware of the degree of his cognitive decline. His wife said she would consider it and discuss it with her husband and their children. She was distraught about the diagnosis of Alzheimer's disease and the future implications for his function and the requirements for his care. She wanted to know if the trial might help him. I explained the principles of a double-blind randomized drug trial and suggested that she discuss her concerns with the researcher conducting it.

Without research there is no progress in Medicine. Most people support the concepts of, and need for, medical research. Throughout history, some form of medical research has occurred. As an outcome of the horrific experiments done on involuntary subjects during the Nazi regime, and the more contemporary American studies on poor black syphilis victims in the Tuskegee experiment and the Willowbrook hepatitis study, a more rigorous and protective approach to human research has been developed.

Contemporary medical researchers are expected to understand the basic ethical principles that govern clinical research.

Christine Oyugi, BSc
Managing Editor,
Geriatrics & Aging

On Friday, January 19th, the Baycrest Centre for Geriatric Care presented the first webcast of its continuing medical education (CME) accredited Grand Rounds program. The webcast featured an exhilarating one-hour talk on research, evaluation, and evidence-based medicine presented by Dr. David Streiner, Director of the Kunin-Lunenfeld Applied Research Unit.

Dr. Streiner began his presentation by providing a definition of the terms, research and evaluation. He defined research as the search for knowledge, where the emphasis is on the outcome and the underlying intention of the research is publication. The results from research are usually peer-reviewed and the recommendations from the study can be generalized to other patients and other institutions. Evaluations, in contrast, are not generalizable; usually they are targeted to local clinicians and administrators who use the results of the evaluation to change clinical programs within the given institution. The results in an evaluation are usually not peer-reviewed, but are vetted internally by the organization where the study took place. Often, the distinguishing factor between research and evaluation is that, in the latter case, there is no intention to publish the results of the study.

Part of EBM is integrating individual clinical practice experience, with the best available evidence and the values and expectations that each patient brings to a clinical encounter.

Since the 1940's, journals have reported an exponential increase in published research. In the field of mental health, for example, there are about 4,500 potentially relevant scientific papers published each year. A physician would have to read at least 12 articles a day to keep up with all the research. With the time constraints on clinicians, it would be difficult for them to read all published papers that are relevant to their particular field and those in other areas. However, the unfortunate consequence of clinicians not keeping up with the latest research is that clinical practice lags behind research, and is then based on the opinion of experts rather than on evidence. The incorporation of new interventions into clinical practice is chaotic, resulting in unnecessary variations in clinical practice.

The idea of evidence-based medicine (EBM) has been around for some time, but recently, there appears to be surge of interest in this topic. EBM is the conscious, explicit, and judicious use of the current best evidence for making patient care decisions. Part of EBM is integrating individual clinical practice experience, with the best available evidence and the values and expectations that each patient brings to a clinical encounter. Individual clinical experience should rely on the clinical skill and judgement of the clinician. This is vital in determining if the evidence applies to the patient being treated and, if it does, in determining how to apply it to that patient. Best evidence should always come from clinical research done with patients.

Physicians need a way to quickly evaluate studies and understand the potential applications of high-quality research to their clinical practice. This involves tracking down the best evidence by using electronic searches (e.g. medline). If judiciously used, EBM can replace currently accepted diagnostic tests and treatments with ones that are more accurate, effective, and better tolerated.

The Baycrest Centre for Geriatric Care is one of the leading institutions in the field of Geriatrics and Gerontology. The webcast is part of an ongoing health information strategy that aims to create and share knowledge to a broad spectrum of individuals and groups. To this end, Baycrest offers a number of on-line resources to facilitate your clinical practice. For more information on CME accredited courses, as well as other useful resources provided at Baycrest, please contact Mariana Catz, Chief Information Officer, at the Baycrest Centre for Geriatrics Care at (416) 785-2500 ext. 2503.

Acknowledgements
We would like to thank Mariana Catz and Stephen Tucker, from the Baycrest Centre for Geriatrics Care, for taking the time to be interviewed for this article.

An Interview with Dr. Derek van der Kooy about His Recent Work on Retinal Stem Cells

Kimby N. Barton, MSc
Assistant Editor
Geriatrics & Aging

In August, this year, the National Institutes of Health generated a firestorm of controversy when they released their new guidelines allowing scientists to use stem cells derived from human embryos for their research. Reactions varied from great praise from the publicly funded Ameri-can scientific community, to a papal condemnation of the action as 'not morally acceptable'.

The various reactions aside, it is widely recognized that stem cell therapy may be one of the only avenues available for treating a number of neurodegenerative disorders, spinal cord injury, and diabetes. The recent success of the 'Edmonton Protocol', which relies on the injection of pancreatic islet cells into a donor pancreas, has raised the possibility of a 'cure' for diabetes. Unfortunately the limited availability of current donors, and the need for two or more pancreases per patient, raise the spectre of a long waiting list of people desperately hoping for a donated organ. One means of overcoming this organ limitation is to develop a renewable line of pancreatic stem cells.

Several articles in this issue offer discussions on the limited success of treatments for such age-related eye diseases as macular degeneration and glaucoma.

 

Kimby Barton, BSc, MSc
Assistant Editor, Geriatrics & Aging

The hematopoietic system is comprised of all the elements of the blood, together with the stem and progenitor cells that give rise to these elements, and these play a vital role in the functioning of a healthy person. The hematopoietic system is unusual in that most of its components have a short life span, a multiplicity of cell types are required for its normal function, and a wide dispersion of cells perform specific functions throughout the body. The short life span of many of its components renders necessary the continuous production of enormous numbers of cells. Consequently, stem and progenitor cells must be maintained in adequate numbers to meet this demand for cell production throughout a person's lifetime.

Age-related alterations have been found in almost all components of the hematopoietic system but historically it has been difficult to distinguish between changes that occur with advanced age and changes that occur as a result of an illness. This article will review some of the literature dealing with the effects of age on the hematopoietic system. Conflicting studies will leave some questions unanswered and a paucity of information in other areas suggests the need for further research.