Showing papers by "Saskatchewan Health published in 2020"
Stanford University1, Intermountain Healthcare2, The Royal Marsden NHS Foundation Trust3, American Society of Clinical Oncology4, University of North Carolina at Chapel Hill5, St. Jude Medical Center6, University of Michigan7, University of Queensland8, University of Texas MD Anderson Cancer Center9, Harvard University10, Yale Cancer Center11, University of Saskatchewan12, Saskatchewan Health13, Cornell University14, University of Milan15, European Institute of Oncology16, Johns Hopkins University17
TL;DR: The Expert Panel continues to recommend ER testing of invasive breast cancers by validated immunohistochemistry as the standard for predicting which patients may benefit from endocrine therapy, and no other assays are recommended for this purpose.
Abstract: PURPOSETo update key recommendations of the American Society of Clinical Oncology/College of American Pathologists estrogen (ER) and progesterone receptor (PgR) testing in breast cancer guideline.M...
510 citations
Stanford University1, Intermountain Healthcare2, The Royal Marsden NHS Foundation Trust3, American Society of Clinical Oncology4, University of North Carolina at Chapel Hill5, St. Jude Medical Center6, University of Michigan7, University of Queensland8, University of Texas MD Anderson Cancer Center9, Harvard University10, Yale Cancer Center11, Saskatchewan Health12, University of Saskatchewan13, Cornell University14, European Institute of Oncology15, University of Milan16, Johns Hopkins University17
TL;DR: The Expert Panel continues to recommend ER testing of invasive breast cancers by validated immunohistochemistry as the standard for predicting which patients may benefit from endocrine therapy, and no other assays are recommended for this purpose.
Abstract: Purpose.— To update key recommendations of the American Society of Clinical Oncology/College of American Pathologists estrogen receptor (ER) and progesterone receptor (PgR) testing in breast cancer...
175 citations
TL;DR: A potential application of the Internet of Things (IoT) in healthcare and physical distance monitoring for pandemic situations and the COVID-SAFE framework can assist in minimizing the coronavirus exposure risk is presented.
Abstract: In the early months of the COVID-19 pandemic with no designated cure or vaccine, the only way to break the infection chain is self-isolation and maintaining the physical distancing. In this article, we present a potential application of the Internet of Things (IoT) in healthcare and physical distance monitoring for pandemic situations. The proposed framework consists of three parts: a lightweight and low-cost IoT node, a smartphone application (app), and fog-based Machine Learning (ML) tools for data analysis and diagnosis. The IoT node tracks health parameters, including body temperature, cough rate, respiratory rate, and blood oxygen saturation, then updates the smartphone app to display the user health conditions. The app notifies the user to maintain a physical distance of 2 m (or 6 ft), which is a key factor in controlling virus spread. In addition, a Fuzzy Mamdani system (running at the fog server) considers the environmental risk and user health conditions to predict the risk of spreading infection in real time. The environmental risk conveys from the virtual zone concept and provides updated information for different places. Two scenarios are considered for the communication between the IoT node and fog server, 4G/5G/WiFi, or LoRa, which can be selected based on environmental constraints. The required energy usage and bandwidth (BW) are compared for various event scenarios. The COVID-SAFE framework can assist in minimizing the coronavirus exposure risk.
154 citations
University of Saskatchewan1, Saskatchewan Health2, Institut Gustave Roussy3, Dalhousie University4, Cross Cancer Institute5, The Chinese University of Hong Kong6, University Health Network7, University of Toronto8, Seoul National University Bundang Hospital9, Laval University10, McGill University11, Texas A&M University12, Mount Sinai Health System13, BC Cancer Agency14, Fujian Medical University15, Nagoya City University16, AstraZeneca17, Yale University18, McMaster University19, Aalborg University20, University of Calgary21, University of Washington22, Tel Aviv Sourasky Medical Center23
TL;DR: Results of this study suggest that, when the testing laboratory is not able to use an Food and Drug Administration-approved companion diagnostic for PD-L1 assessment for its specific clinical purpose, it is better to develop a properly validated laboratory developed test for the same purpose(s).
129 citations
TL;DR: Analytical sensitivities were equivalent between LDTs and most commercially available methods, and some commercially available real-time RT-PCR assays.
92 citations
Alberta Children's Hospital1, University of Auckland2, Carilion Clinic3, Saskatchewan Health4, University of Calgary5, Tufts University6, University of Colorado Denver7, El Bosque University8, Baylor College of Medicine9, Royal Victoria Infirmary10, McMaster University11, Yale University12, University of Liège13, Hofstra University14, Case Western Reserve University15, University of Louisville16, Mount Sinai Hospital, Toronto17
TL;DR: Challenges associated with such arbitrary cut-offs and opportunities for further refinement of understanding growth and nutritional needs of preterm neonates are highlighted.
Abstract: Preterm infants are increasingly diagnosed as having "extrauterine growth restriction" (EUGR) or "postnatal growth failure" (PGF). Usually EUGR/PGF is diagnosed when weight is <10th percentile at either discharge or 36-40 weeks postmenstrual age. The reasons why the phrases EUGR/PGF are unhelpful include, they: (i) are not predictive of adverse outcome; (ii) are based only on weight without any consideration of head or length growth, proportionality, body composition, or genetic potential; (iii) ignore normal postnatal weight loss; (iv) are usually assessed prior to growth slowing of the reference fetus, around 36-40 weeks, and (v) are usually based on an arbitrary statistical growth percentile cut-off. Focus on EUGR/PGF prevalence may benefit with better attention to nutrition but may also harm with nutrition delivery above infants' actual needs. In this paper, we highlight challenges associated with such arbitrary cut-offs and opportunities for further refinement of understanding growth and nutritional needs of preterm neonates.
68 citations
TL;DR: The short term use of SGLT2 inhibitors was associated with a decreased risk of cardiovascular events compared with the use of DPP-4 inhibitors, and similar benefits for MACE were observed with canagliflozin.
Abstract: Objective To compare the risk of cardiovascular events between sodium glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors among people with type 2 diabetes in a real world context of clinical practice. Design Multi-database retrospective cohort study using a prevalent new user design with subsequent meta-analysis. Setting Canadian Network for Observational Drug Effect Studies (CNODES), with administrative healthcare databases from seven Canadian provinces and the United Kingdom, 2013-18. Population 209 867 new users of a SGLT2 inhibitor matched to 209 867 users of a DPP-4 inhibitor on time conditional propensity score and followed for a mean of 0.9 years. Main outcome measures The primary outcome was major adverse cardiovascular events (MACE, a composite of myocardial infarction, ischaemic stroke, or cardiovascular death). Secondary outcomes were the individual components of MACE, heart failure, and all cause mortality. Cox proportional hazards models were used to estimate site specific adjusted hazards ratios and 95% confidence intervals, comparing use of SGLT2 inhibitors with use of DPP-4 inhibitors in an as treated approach. Site specific results were pooled using random effects meta-analysis. Results Compared with DPP-4 inhibitors, SGLT2 inhibitors were associated with decreased risks of MACE (incidence rate per 1000 person years: 11.4 v 16.5; hazard ratio 0.76, 95% confidence interval 0.69 to 0.84), myocardial infarction (5.1 v 6.4; 0.82, 0.70 to 0.96), cardiovascular death (3.9 v 7.7; 0.60, 0.54 to 0.67), heart failure (3.1 v 7.7; 0.43, 0.37 to 0.51), and all cause mortality (8.7 v 17.3; 0.60, 0.54 to 0.67). SGLT2 inhibitors had more modest benefits for ischaemic stroke (2.6 v 3.5; 0.85, 0.72 to 1.01). Similar benefits for MACE were observed with canagliflozin (0.79, 0.66 to 0.94), dapagliflozin (0.73, 0.63 to 0.85), and empagliflozin (0.77, 0.68 to 0.87). Conclusions In this large observational study conducted in a real world clinical practice context, the short term use of SGLT2 inhibitors was associated with a decreased risk of cardiovascular events compared with the use of DPP-4 inhibitors. Trial registration ClinicalTrials.gov NCT03939624.
57 citations
TL;DR: Findings of this study suggest that, while mindfulness and resilience are important qualities for medical student well-being, their stress-protective benefits may diminish when students’ basic psychological needs are frustrated in medical school.
Abstract: Medical student distress is an increasing concern in medical education. Addressing this issue requires a comprehensive understanding of what factors influence learners’ stress in medical school. Gr...
28 citations
TL;DR: Accessibility to public MPTFs continues to be limited in Canada, resulting in lengthy wait times for a first appointment, and community-based MP TFs and virtual care initiatives to distribute pain services into regional and remote communities are needed to provide patients with CP with optimal care.
25 citations
Jewish General Hospital1, International Council for the Exploration of the Sea2, University of Toronto3, Sunnybrook Health Sciences Centre4, McGill University5, Saskatchewan Health6, University of Manitoba7, University of British Columbia8, Memorial University of Newfoundland9, University of Calgary10
TL;DR: There was no association between SGLT2 inhibitor use and incident below-knee amputations among patients with type 2 diabetes compared with DPP-4 inhibitor use, and studies with a longer duration of follow-up are needed to assess potential long-term effects.
Abstract: OBJECTIVE Reports of amputations associated with sodium–glucose cotransporter 2 (SGLT2) inhibitors have been inconsistent. We aimed to compare the risk of below-knee amputation with SGLT2 inhibitors versus dipeptidyl peptidase 4 (DPP-4) inhibitors among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS This multicenter observational study used administrative health care databases from seven Canadian provinces and the U.K. Incident SGLT2 inhibitor users were matched to DPP-4 inhibitor users using a prevalent new-user design and time-conditional propensity scores. Cox proportional hazards models were used to estimate site-specific adjusted hazard ratios (HR) and corresponding 95% CIs of incident below-knee amputation for SGLT2 inhibitor versus DPP-4 inhibitor users. Random effects meta-analyses were used to pool the site-specific results. RESULTS The study cohort included 207,817 incident SGLT2 inhibitor users matched to 207,817 DPP-4 inhibitor users. During a mean exposed follow-up time of 11 months, the amputation rate was 1.3 per 1,000 person-years among SGLT2 inhibitor users and 1.5 per 1,000 person-years among DPP-4 inhibitor users. The adjusted HR of below-knee amputations associated with SGLT2 inhibitor use compared with DPP-4 inhibitor use was 0.88 (95% CI 0.71–1.09). Similar results were obtained in stratified analyses by specific SGLT2 inhibitor molecule. CONCLUSIONS In this large multicenter observational study, there was no association between SGLT2 inhibitor use and incident below-knee amputations among patients with type 2 diabetes compared with DPP-4 inhibitor use. While these findings provide some reassurance, studies with a longer duration of follow-up are needed to assess potential long-term effects.
21 citations
TL;DR: A systematic review of the literature to identify interventions that improve mental wellness through all developmental stages for people with prenatal alcohol exposure (PAE) and FASD provided preliminary and emerging evidence for a range of intervention approaches that may support positive outcomes for individuals with FASd across the life course.
Abstract: Individuals with fetal alcohol spectrum disorder (FASD) experience remarkably high rates of mental health and substance use challenges, beginning early in life and extending throughout adulthood. Proactive intervention can help to mitigate some of these negative experiences. Although the literature on FASD intervention is growing, there is currently a lack of consolidated evidence on interventions that may improve mental health and substance use outcomes in this population. Informed by a life course perspective, we undertook a systematic review of the literature to identify interventions that improve mental wellness through all developmental stages for people with prenatal alcohol exposure (PAE) and FASD. A total of 33 articles were identified, most of which were focused on building skills or strategies that underlie the well-being of children with PAE and FASD and their families. Other interventions were geared toward supporting child and family wellness and responding to risk or reducing harm. There was a notable lack of interventions that directly targeted mental health and substance use challenges, and a major gap was also noted in terms of interventions for adolescents and adults. Combined, these studies provide preliminary and emerging evidence for a range of intervention approaches that may support positive outcomes for individuals with FASD across the life course.
TL;DR: This research provides foundational, strong evidence that seniors’ cohousing is an innovative housing solution that can support older adults’ quality of life.
Abstract: The global population including Canada's is aging, which demands planning for housing that will support older adults' quality of life. This mixed-method study is the first Canadian study to examine the impact of cohousing on older adults' quality of life and involved 23 participants. The older adults rated their quality of life very high, especially in the environmental, physical, and psychological domains of the World Health Organization Quality of Life (WHOQOL_BREF) survey; quality of life in the social domain was rated low, which was surprising in light of the focus group data findings. Four themes of "belonging in a community", "life in the community", "changes associated with aging," and "aging in place" emerged from the qualitative data to explain factors that influence older adults' quality of life. This research provides foundational, strong evidence that seniors' cohousing is an innovative housing solution that can support older adults' quality of life.
TL;DR: A "viral prescription pad" was developed to provide a tool to help PHC providers engage in patient education regarding appropriate antimicrobial use, specifically for URTIs and was deemed to be a useful educational tool.
Abstract: In order to combat rising rates of antimicrobial resistant infections, it is vital that antimicrobial stewardship become embedded in primary health care (PHC). Despite the high use of antimicrobials in PHC settings, there is a lack of data regarding the integration of antimicrobial stewardship programs (ASP) in non-hospital settings. Our research aimed to determine which antimicrobial stewardship interventions are optimal to introduce into PHC clinics beginning to engage with an ASP, as well as how to optimize those interventions. This work became focused specifically around management of viral upper respiratory tract infections (URTIs), as these infections are one of the main sources of inappropriate antibiotic use. This mixed methods study of sequential explanatory design was developed through three research projects over 3 years in Regina, Saskatchewan, Canada. First, a survey of PHC providers was performed to determine their perceived needs from a PHC-based ASP. From this work, a “viral prescription pad” was developed to provide a tool to help PHC providers engage in patient education regarding appropriate antimicrobial use, specifically for URTIs. Next, interviews were performed with family physicians to discuss their perceived utility of this tool. Finally, we performed a public survey to determine preferences for the medium by which information is received regarding symptom management for viral URTIs. The majority of PHC providers responding to the initial survey indicated they were improperly equipped with tools to aid in promoting conversations with patients and providing education about the appropriate use of antimicrobials. Following dissemination of the viral prescription pad and semi-structured interviews with family physicians, the viral prescription pad was deemed to be a useful educational tool. However, about half of the physicians interviewed indicated they did not actually provide a viral prescription to patients when providing advice on symptom management for viral URTIs. When asked about their preferences, 76% of respondents to the public survey indicated they would prefer to receive written or a combination of verbal and written information in this circumstance. PHC providers indicated a need for educational tools to promote conversations with patients and provide education about the appropriate use of antimicrobials. Viral prescription pads were regarded by family physicians and patients as useful tools in facilitating discussion on the appropriate use of antimicrobials. PHC providers should exercise caution in opting out of providing written forms of information, as many respondents to the general public survey indicated their preference in receiving both verbal and written information.
TL;DR: It is concluded that neither completion of homework questionnaires nor offering twice-weekly support significantly improve iCBT in routine care.
TL;DR: A prospective cohort study involving 100 prevalent HD patients to evaluate changes in frailty status, level of independence, mood, cognition, and quality of life (QoL) over a 12-month period and explore the relationship among patients on hemodialysis and nonfrail groups at 2 different time points.
Abstract: Background:The prevalence of frailty is disproportionately increased in patients with chronic kidney disease (CKD) in comparison with non-CKD counterparts and is the highest in patients on hemodial...
TL;DR: Fundamental to a PFCC MAID program, practitioners must be afforded time to provide holistic care, and program-related suggestions include incorporating interdisciplinary care early, and throughout the illness trajectory.
Abstract: Background:Medical Assistance in Dying (MAID) became legal in Canada in June 2016. As part of a project designed to improve end-of-life care for those requesting MAID, qualitative data from patient...
TL;DR: To use the Canadian Network for Observational Drug Effect Studies (CNODES) to describe drug utilization of antidiabetic medications in four Canadian provinces.
Abstract: Purpose To use the Canadian Network for Observational Drug Effect Studies (CNODES) to describe drug utilization of antidiabetic medications in four Canadian provinces. Methods With the use of data from CNODES, we constructed cohorts of patients with type 2 diabetes in four Canadian provinces (Manitoba, Ontario, Quebec, and Saskatchewan) who received their first-ever prescription for a noninsulin antidiabetic medication during the study period, defined as the earliest date of data availability in each province (range: 1993-1998) to the latest date of the data extraction in each province (range: 2013-2014). Prescriptions rates were calculated for all prescriptions by class and described over time. Results Across provinces, we identified 650 830 patients who initiated antidiabetic medications during the study period. In most provinces, the overall prescription rate of antidiabetic medications increased during the last two decades. Metformin particularly increased in popularity, surpassing sulfonylureas in all provinces as the most widely prescribed antidiabetic medication by the early 2000s. Thiazolidinediones grew in popularity from the onset of their availability until 2006 to 2007, at which point they rapidly declined. Dipeptidyl peptidase-4 inhibitors saw substantial growth in several provinces following their addition to provincial formularies in 2008 to 2012, while glucagon-like peptide-1 agonists experienced modest growth. Insulin prescription rates remained constant or steadily increased over the last two decades. Conclusions CNODES can be used for cross-jurisdictional drug utilization studies. In Canada, trends in antidiabetic medication prescriptions followed changing guidelines reflecting up-to-date knowledge of drug effectiveness and safety.
TL;DR: It is suggested that more effort is needed to harmonise assessment and treatment approaches between professions, and addressing discrepancies in practice could help prioritise professional roles, and better support the management of children with foot pain.
Abstract: This study sought to explore professional perspectives on the assessment and management of symptomatic pes planus in children. Data was collected from three professional groups (podiatrists, physiotherapists, and orthotists) with experience of managing foot problems in children. The survey was undertaken in the United Kingdom via a self-administered, online survey. Data was captured over a four-month period in 2018. Fifty-five health professionals completed the survey and the results highlighted that assessment techniques varied between professions, with standing tip-toe and joint range of motion being the most common. Treatment options for children were diverse and professionals were adopting different strategies as their first line intervention. All professions used orthoses. There were inconsistencies in how the health professionals assessed children presenting with foot symptoms, variation in how the condition was managed and differences in outcome measurement. These findings might be explained by the lack of robust evidence and suggests that more effort is needed to harmonise assessment and treatment approaches between professions. Addressing discrepancies in practice could help prioritise professional roles in this area, and better support the management of children with foot pain.
TL;DR: This pragmatic trial will assess whether adopting lower female hs-cTn thresholds leads to appropriate assessment of women with symptoms suggestive of myocardial infarction, thereby improving treatment and outcomes.
TL;DR: There was variable uptake of the PtDAs between the cases and several strategies were identified to increase or sustain PtDA use.
Abstract: Background There are multiple options for men diagnosed with localized prostate cancer. Patient decision aids (PtDAs) help empower individuals and reduce unwarranted practice variation, but few are used in clinical practice. Objective We compared 2 programs implementing PtDAs for men with localized prostate cancer. Methods This was a comparative case study. Case 1 was a hospital prostate pathway and case 2 was a provincial prostate pathway with 2 locations (2a, 2b). Nurses provided the men with PtDAs and answered questions. Data sources were as follows: (a) 2 years administrative data for men with localized prostate cancer, (b) clinicians survey and interviews, and (c) patients/spouses interviews. Analysis was within and across cases. Results The PtDA was used with 23% of men in case 1 (95% confidence interval, 19.8%-26.1%) and 98% of men in case 2a (95% confidence interval, 96.5%-99.8%). The pathway was not implemented in case 2b. Men given the PtDA had positive experiences. Many clinicians supported the use of PtDAs, some adapted their discussions with patients, and others did not support the use of PtDAs. To increase use in case 1, participants identified needing a Canadian PtDA available electronically and endorsed by all clinicians. In case 2b, the provincial prostate pathway needed to be implemented. Conclusions There was variable uptake of the PtDAs between the cases. Men who received the PtDA had positive outcomes. Several strategies were identified to increase or sustain PtDA use. Implications for practice Nurses have a key role in supporting men making decisions about prostate cancer treatment by providing PtDAs, answering questions, and advocating for men's preferences.
Public Health Agency of Canada1, Université de Montréal2, McGill University Health Centre3, Ottawa Hospital4, Dalhousie University5, Halifax6, Alberta Health Services7, London Health Sciences Centre8, University of Western Ontario9, University of Waterloo10, University of Manitoba11, Boston Children's Hospital12, Hôpital Maisonneuve-Rosemont13, Kingston General Hospital14, University of British Columbia15, North York General Hospital16, Royal Jubilee Hospital17, Saskatchewan Health18, University of Alberta19, Sunnybrook Research Institute20, University of Toronto21, Nova Scotia Health Authority22, Sunnybrook Health Sciences Centre23, Jewish General Hospital24, University of Calgary25
TL;DR: This study presents benchmark antimicrobial use rates for inpatient adult populations in acute-care hospitals across Canada, and represents the largest collection of dispensed antimicrobials use data among inpatients in Canada to date.
Abstract: Antimicrobial resistance is a growing threat to the world’s ability to prevent and treat infections. Links between quantitative antibiotic use and the emergence of bacterial resistance are well documented. This study presents benchmark antimicrobial use (AMU) rates for inpatient adult populations in acute-care hospitals across Canada. In this retrospective surveillance study, acute-care adult hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) submitted annual AMU data on all systemic antimicrobials from 2009 to 2016. Information specific to intensive care units (ICUs) and non-ICU wards were available for 2014–2016. Data were analyzed using defined daily doses (DDD) per 1000 patient days (DDD/1000pd). Between 2009 and 2016, 16–18 CNISP adult hospitals participated each year and provided their AMU data (22 hospitals participated in ≥1 year of surveillance; 11 in all years). From 2009 to 2016, there was a significant reduction in use (12%) (from 654 to 573 DDD/1000pd, p = 0.03). Fluoroquinolones accounted for the majority of this decrease (47% reduction in combined oral and intravenous use, from 129 to 68 DDD/1000pd, p < 0.002). The top five antimicrobials used in 2016 were cefazolin (78 DDD/1000pd), piperacillin-tazobactam (53 DDD/1000pd), ceftriaxone (49 DDD/1000pd), vancomycin (combined oral and intravenous use was 44 DDD/1000pd; 7% of vancomycin use was oral), and ciprofloxacin (combined oral and intravenous use: 42 DDD/1000pd). Among the top 10 antimicrobials used in 2016, ciprofloxacin and metronidazole use decreased significantly between 2009 and 2016 by 46% (p = 0.002) and 26% (p = 0.002) respectively. Ceftriaxone (85% increase, p = 0.0008) and oral amoxicillin-clavulanate (140% increase, p < 0.0001) use increased significantly but contributed only a small component (8.6 and 5.0%, respectively) of overall use. This study represents the largest collection of dispensed antimicrobial use data among inpatients in Canada to date. Between 2009 and 2016, there was a significant 12% decrease in AMU, driven primarily by a 47% decrease in fluoroquinolone use. Modest absolute increases in parenteral ceftriaxone and oral amoxicillin-clavulanate use were noted but contributed a small amount of total AMU. Ongoing national surveillance is crucial for establishing benchmarks and antimicrobial stewardship guidelines.
TL;DR: In this large multi-site study, an increased risk for urosepsis associated with SGLT2i compared with DPP4i among patients with type 2 diabetes in a real-world setting was not observed.
Abstract: Aim: To compare urosepsis rates in patients with type 2 diabetes treated using sodium-glucose co-transporter-2 inhibitors (SGLT2i) with dipeptidyl peptidase-4 inhibitors (DPP4i) in a real-world setting.
Methods: We conducted a matched cohort study using a prevalent new-user design with time-conditional propensity scores. New users of SGLT2i from seven Canadian provinces and the UK were matched to DPP4i users. The primary outcome was hospitalization with a diagnosis of urosepsis and the secondary outcome was Fournier's gangrene. Site-specific hazard ratios for urosepsis comparing SGLT2i with DPP4i were estimated using Cox proportional hazards models and pooled using a random effects meta-analysis.
Results: We included 208 244 users of SGLT2i and 208 244 users of DPP4i. Among SGLT2i users, 42% initiated canagliflozin, 31% dapagliflozin and 27% empagliflozin. During a mean follow-up of 0.9 years, patients initiating SGLT2i had a lower rate of urosepsis compared with those receiving DPP4i. The pooled adjusted hazard ratio was 0.58 (95% confidence interval [CI]: 0.42-0.80). The incidence rates of Fournier's gangrene were numerically similar in SGLT2i (0.08 per 1000 person-years; 95% CI: 0.05-0.13) and DPP4i users (0.14; 95% CI: 0.09-0.21).
Conclusions: In this large, multi-site study, we did not observe an increased risk for urosepsis associated with SGLT2i compared with DPP4i among patients with type 2 diabetes in a real-world setting.
TL;DR: The results showed tensions in the implementation of a Lean model adapted in the context of health care organisations, which significantly impact the roles of nurse managers who require adequate resources and training to successfully adapt.
Abstract: Aim This study explores the perceptions and experiences of nurse managers involved in implementing the Lean management system in a Western Canadian province. Background The provincial government of Saskatchewan, Canada, implemented a multimillion-dollar investment in the Lean management system to transform health care delivery by reducing waste and increasing efficiency of processes and outcomes. Methods This qualitative exploratory study employed semi-structured interviews with 14 nurse managers in urban and rural health regions in one Canadian province. Results Six themes outline the difficulties nurse managers experienced in juggling role responsibilities alongside a poorly implemented change system with scarce resources. Conclusion The results showed tensions in the implementation of a Lean model adapted in the context of health care organisations. The expectations for nurse managers to be pivotal players in the implementation of transformative health care practices that promote and sustain strategies to reduce waste, improve coordination and increase patient safety require investment in leadership development. Implications for nursing management Lean management systems significantly impact the roles of nurse managers who require adequate resources and training to successfully adapt. The results of this study may be used for more effective support mechanisms for nurse managers.
TL;DR: The amount of alveolar overdistention was quantified before applying higher PEEP in the authors' patients with coronavirus disease (COVID19)–related ARDS and this approach resulted in low driving pressures and low transpulmonary pressures in all their patients.
Abstract: our patients. The Alveolar Recruitment Trial showed us that systematically performed recruitment maneuvers, known to cause alveolar overdistention, increased mortality rate in patients with acute respiratory distress syndrome (ARDS) (2). However, the amount of alveolar overdistention or collapse prior to the application of high airway pressures was unknown. Determining alveolar overdistention and collapse is crucial, as PEEP titration approaches are based on the assumption that there is an optimal compromise between alveolar recruitment (i.e., limit the amount of collapse) and minimizing alveolar overdistention. Numerous bedside PEEP titration approaches have been described, but none have shown to improve patient survival in large randomized controlled trials. In addition, correlation between different approaches is poor. The explanation is that most bedside PEEP titration approaches have at least one of the following three limitations: 1) the approach does not quantify alveolar recruitment; 2) the respiratory system is assessed as a whole, and local lung inhomogeneities remain undetected; and 3) alveolar overdistention is not quantified. EIT is a functional imaging tool that continuously assesses regional ventilation and lung volume changes at the bedside. As such, EIT is a bedside PEEP titration approach that quantifies both alveolar recruitment and alveolar overdistention and is able to detect local lung inhomogeneities. However, the amount of studies that used EIT to titrate PEEP in critically ill patients with ARDS is limited. In addition, there is no consensus on how to interpret EIT data. Blankman and colleagues (3) compared several EIT-derived PEEP titration approaches in patients after cardiac surgery and proposed the intratidal gas distribution index to identify alveolar overdistention in the nondependent lung regions and to titrate PEEP. In a case series, Yoshida and colleagues (4) used a ventral-dorsal ventilation distribution of 50–50% to reach homogeneous ventilation and limit alveolar overdistention. In contrast, Franchineau and colleagues (5) aimed to limit the amount of relative collapse to 15% while maintaining the lowest percentage of overdistention in patients with extracorporeal membrane oxygenation. Alternatively, we could have aimed for the greatest amount of ventilated pixels or calculate the global inhomogeneity index. We chose to titrate PEEP at the lowest level of relative alveolar overdistention and collapse, as it is a simple and intuitive approach that has proven to be beneficial in mechanically ventilated patients during surgery (6). This approach resulted in low driving pressures and low transpulmonary pressures in all our patients. We share the concerns of van den Berg and van der Hoeven that alveolar overdistention is harmful to the lungs. Therefore, we quantified the amount of alveolar overdistention before applying higher PEEP in our patients with coronavirus disease (COVID19)–related ARDS. The Pleural Pressure Working Group’s planned RECRUIT (Recruitment Assessed by Electrical Impedance Tomography: Feasibility, Correlation with Clinical Outcomes and Pilot Data on Personalised PEEP Selection) project (https:// www.plugwgroup.org/), which aims to compare the results of different bedside methods to titrate PEEP based on EIT, might provide us with some answers on how to titrate PEEP using EIT data. In the meantime, we agree with our colleagues to limit the amount of alveolar overdistention in patients with COVID19–related ARDS by applying prone positioning and quantifying the amount of alveolar overdistention during a PEEP trial. n Author disclosures are available with the text of this letter at www.atsjournals.org.
TL;DR: Comorbid alcohol use disorder was found to be a strong risk factor for the persistence or recurrence of major depression in a Canadian population sample.
Abstract: ObjectiveThis study aims to determine the role of alcohol use disorder and other potential risk factors on persistence/recurrence of major depression in a Canadian population sample.MethodsData wer...
University of Ottawa1, Ottawa Hospital2, Hamilton Health Sciences3, Royal College of Physicians and Surgeons of Canada4, Ottawa Hospital Research Institute5, Saskatchewan Health6, Canadian Blood Services7, McGill University8, Laval University9, University of Calgary10, Dalhousie University11, Children's Hospital of Eastern Ontario12, Université de Montréal13, Horizon Health Network14, St. John's University15, University of Manitoba16, University of Alberta17
TL;DR: Study findings will help improve healthcare provider competency in caring for potential organ donors and their families and improve organ donation consent rates and help with the development of educational materials for a competency-based curriculum for critical care residents.
Abstract: Introduction In a patient-centred and family-centred approach to organ donation, compassion is paramount. Recent guidelines have called for more research, interventions and approaches aimed at improving and supporting the families of critically ill patients. The objective of this study is to help translate patient-centred and family-centred care into practice in deceased organ donation. Methods and analysis This will be a national, qualitative study of family members of deceased organ donors in Canada. We will include family members who had been approached regarding an organ donation decision, including those who agreed and declined, at least 2 months and no later than 3 years after the patients’ death. Data collection and analysis is ongoing and will continue until September 2020 to include approximately 250 participants. Family members will be identified and recruited from provincial organ donation organisation databases. Four experienced qualitative researchers will conduct telephone interviews in English or French with audio-recording for subsequent transcription. The research team will develop a codebook iteratively through this process using inductive methods, thus generating themes directly from the dataset. Ethics and dissemination Local research ethics boards (REB) at all participating sites across Canada have approved this protocol. The main REB involved is the Ottawa Health Science Network REB. Data collection began in August 2018. Publication of results is anticipated in 2021. Study findings will help improve healthcare provider competency in caring for potential organ donors and their families and improve organ donation consent rates. Findings will also help with the development of educational materials for a competency-based curriculum for critical care residents.
TL;DR: Factors that influence WTSR of SFs are identified and indicates that HCPs make tradeoffs between patient preference and other outcome characteristics, which can inform clinical scenarios and models aiming to understand shared decision-making, patient and family opportunity to benefit, and cost-effectiveness.
TL;DR: Findings highlight the need for mandated GF folate food fortification policy among children with CD on the gluten-free diet and folate content of household food purchases.
Abstract: The lack of mandated folate enrichment of gluten-free (GF) grains in Canada has been suspected to contribute to suboptimal folate intake among children suffering from Celiac disease (CD). Children ...
TL;DR: Strategies to help improve home-based dialysis included improved education, local support, integrated traditional medicine, cultural sensitivity, and leadership prioritization.
Abstract: Background:Renal replacement options or dialysis can be delivered in the home setting or hospital setting. Home dialysis offers a number of benefits over hospital-delivered dialysis. These advantag...