Saskatchewan Health

About: Saskatchewan Health is a government organization based out in Regina, Saskatchewan, Canada. It is known for research contribution in the topics: Population & Health care. The organization has 442 authors who have published 489 publications receiving 7728 citations.

An Expanded COVID-19 Telemedicine Intermediate Care Model Using Repurposed Hotel Rooms.

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.

Alcohol Use Disorder and the Persistence/Recurrence of Major Depression: Le trouble de l’usage de l’alcool et la persistance/récurrence de la dépression majeure:

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...

A comparison of the Genie and western blot assays in confirmatory testing for HIV-1 antibody.

Abstract: The Genie HIV-1/2 kit (Sanofi Diagnostics Pasteur, Montreal, Quebec), a synthetic-peptide solid-phase enzyme immunoassay, was evaluated as a confirmatory assay for HIV-1 antibodies in comparison with Western blot (BioRad, Hercules, CA, USA) on 50 stored HIV-1 antibody-positive sera and the 137 sera yielding repeated positive results in the conventional EIA screen out of 13405 fresh patient sera from Saskatchewan in 1993. The stored HIV-1-positive sera were uniformly positive in the Genie test. Of the 137 EIA screen-positive sera, 33 were uniformly positive and 64 were uniformly negative in Genie and Western blot; 36 were Genie-negative and indeterminate by Western blot; and four were Genie indeterminate, of which one was negative and three were indeterminate by Western blot. All HIV-1 Western blot-indeterminate and Genie-interdeterminate sera were negative in radio-immunoprecipitation assay (RIPA) and Western blot for HIV-1 and HIV-2 antibodies performed by a reference laboratory. Genie gave an accurate definitive result for 97% of EIA positive sera compared with 71% for Western blot. There was excellent correlation between Genie, Western blot and RIPA results. However, the Genie assay was faster, less costly and yielded fewer indeterminate results than Western blot in confirmatory testing for HIV-1 antibodies.

Association between asthma control trajectories in preschoolers and disease remission.

Abstract: Introduction Early disease morbidity has been associated with asthma persistence in wheezing preschoolers; however, whether asthma control trajectories shortly after diagnosis could influence remission is unknown. We examined the association between asthma control trajectories 2 years post-diagnosis in preschoolers and subsequent disease remission. Methods We conducted a multicentre population-based retrospective cohort study consisting of 48 687 children with asthma diagnosed before 5 years old and born between 1990 and 2013 in four Canadian provinces who had prolonged disease activity post-diagnosis. Prolonged disease activity was defined as one or more medical visits or medications for asthma every 6-month period for at least four of the six periods post-diagnosis. Follow-up began at 3 years post-diagnosis (at cohort entry). Remission was defined as 2 consecutive years without drug claims or medical visits for asthma or asthma-like conditions following cohort entry. Asthma control trajectories, ascertained over four 6-month periods following diagnosis using a validated index, were classified as: “controlled throughout”, “improving control”, “worsening control”, “out of control throughout” and “fluctuating control”. Adjusted Cox models estimated associations between asthma control trajectories and time to remission. A random effects meta-analysis summarised province-specific hazard ratios (HRs). Results The pooled remission rate was 8.91 (95% CI 8.80–9.02) per 100 person-years. Compared with children controlled throughout, poorer asthma control was associated with incrementally lower hazard ratios of remission in four other trajectories: improving control (HR 0.89, 95% CI 0.82–0.96), fluctuating control (HR 0.78, 95% CI 0.71–0.85), worsening control (HR 0.68, 95% CI 0.62–0.75) and out of control throughout (HR 0.52, 95% CI 0.45–0.59). Conclusions Asthma control trajectories 2 years following a diagnosis in preschoolers were associated with remission, highlighting the clinical relevance of documenting control trajectories in early life.

Importance of clinical educators to research use and suggestions for better efficiency and effectiveness: results of a cross-sectional survey of care aides in Canadian long-term care facilities.

Abstract: Objective This study explored the effect of clinical educators as facilitators of research use and how it may be modified by organisational context in the settings. Design Cross-sectional observational study. Setting A representative sample of 91 residential long-term care (LTC) facilities across Western Canada. Participants We used surveys to collect data from the frontline care aides and information about the organisational context of the care units. Outcome measure and explanatory variables We assessed research use (the outcome) with the Conceptual Research Utilization (CRU) scale. Explanatory variables in the multiple regression analysis were facilitation, organisational context and the interaction terms. Facilitation was measured by the frequency of contacts between care aides and clinical educator or person who brings new ideas about resident care. Three core organisational context variables were measured using the Alberta Context Tool. Results We included data of 3873 care aides from 294 care units in the LTC facilities. We found significant associations between CRU and facilitation, leadership, culture and evaluation. Interactions of facilitation x leadership and facilitation x culture were negative. The coefficient of the facilitation x evaluation term in the regression model was positive (0.019, 95% CI 0.012 to 0.026), suggesting synergistic effects between facilitation and a well-developed process to evaluate care quality using relevant data. Conclusions Findings indicate clinical educators are effective facilitators of research use among the care aides, but the effect is modified by organisational context. For greatest impact, managers can direct efforts of the clinical educators to care units where leadership and culture ratings are lowest, but a proficient feedback and evaluation process is in place. This understanding enables managers to deploy clinical educators (a scarce resource in LTC settings) most efficiently.