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An improved understanding of diagnostic and treatment practices for patients with rare primary mitochondrial disorders can support benchmarking against guidelines and establish priorities for evaluative research. We aimed to describe physician care for patients with mitochondrial diseases in Canada, including variation in care.
We conducted a cross-sectional survey of Canadian physicians involved in the diagnosis and/or ongoing care of patients with mitochondrial diseases. We used snowball sampling to identify potentially eligible participants, who were contacted by mail up to five times and invited to complete a questionnaire by mail or internet. The questionnaire addressed: personal experience in providing care for mitochondrial disorders; diagnostic and treatment practices; challenges in accessing tests or treatments; and views regarding research priorities.
We received 58 survey responses (52% response rate). Most respondents (83%) reported spending 20% or less of their clinical practice time caring for patients with mitochondrial disorders. We identified important variation in diagnostic care, although assessments frequently reported as diagnostically helpful (e.g., brain magnetic resonance imaging, MRI/MR spectroscopy) were also recommended in published guidelines. Approximately half (49%) of participants would recommend “mitochondrial cocktails” for all or most patients, but we identified variation in responses regarding specific vitamins and cofactors. A majority of physicians recommended studies on the development of effective therapies as the top research priority.
While Canadian physicians’ views about diagnostic care and disease management are aligned with published recommendations, important variations in care reflect persistent areas of uncertainty and a need for empirical evidence to support and update standard protocols.
In satire, evil, folly, and weakness are held up to ridicule - to the delight of some and the outrage of others. Satire may claim the higher purpose of social critique or moral reform, or it may simply revel in its own transgressive laughter. It exposes frauds, debunks ideals, binds communities, starts arguments, and evokes unconscious fantasies. It has been a central literary genre since ancient times, and has become especially popular and provocative in recent decades. This new introduction to satire takes a historically expansive and theoretically eclectic approach, addressing a range of satirical forms from ancient, Renaissance, and Enlightenment texts through contemporary literary fiction, film, television, and digital media. The beginner in need of a clear, readable overview and the scholar seeking to broaden and deepen existing knowledge will both find this a lively, engaging, and reliable guide to satire, its history, and its continuing relevance in the world.