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.

Nutritional considerations of a paediatric gluten-free food guide for coeliac disease.

Abstract: The gluten-free (GF) diet is the only treatment for coeliac disease (CD). While the GF diet can be nutritious, increased reliance on processed and packaged GF foods can result in higher fat/sugar and lower micronutrient intake in children with CD. Currently, there are no evidence-based nutrition guidelines that address the GF diet. The objective of this cross-sectional study was to describe the methodological considerations in forming a GF food guide for Canadian children and youth (4-18 years) with CD. Food guide development occurred in three phases: (1) evaluation of nutrient intake and dietary patterns of children on the GF diet, (2) pre-guide stakeholder consultations with 151 health care professionals and 383 community end users and (3) development of 1260 GF diet simulations that addressed cultural preferences and food traditions, diet patterns and diet quality. Stakeholder feedback identified nutrient intake and food literacy as important topics for guide content. Except for vitamin D, the diet simulations met 100 % macronutrient and micronutrient requirements for age-sex. The paediatric GF plate model recommends intake of >50 % fruits and vegetables (FV), <25 % grains and 25 % protein foods with a stronger emphasis on plant-based sources. Vitamin D-fortified fluid milk/unsweetened plant-based alternatives and other rich sources are important to optimise vitamin D intake. The GF food guide can help children consume a nutritiously adequate GF diet and inform policy makers regarding the need for nutrition guidelines in paediatric CD.

Lexigene®: An online medical genetics translation tool to facilitate communication.

Abstract: 1Regional Genetics Program, Children’s Hospital of Eastern Ontario, Ottawa, Canada 2Blueprint Genetics, San Francisco, California 3Division of Medical Genetics, Department of Pediatrics, Saskatchewan Health Authority, Saskatoon, Canada 4The University of Texas Health Science Center at Houston, Texas 5Division of Medical Genetics, Department of Medicine, McGill University Health Centre, Montreal, Canada

Identification of Staphylococci by Polymerase Chain Reaction Directly from a Positive Blood Culture and Effect on Patient Care.

Abstract: Background: As one of the most common bloodstream infections worldwide, Staphylococcus aureus bacteremia places a major burden on health care. Implementation of a rapid, genetic-based diagnostic test may have important implications in the clinical management of patients with S. aureus bacteremia. Objectives: The primary objective was to assess concordance between testing based on polymerase chain reaction (PCR) and the current gold standard, culture and sensitivity testing; the secondary objective was to assess the impact of this technology on patient care. Methods: A pre–post intervention retrospective chart review was used to document the hospital course of patients with a diagnosis of S. aureus bacteremia before and after implementation of the PCR-based diagnostic system. Laboratory results from all patient samples subjected to PCR-based analysis following implementation of this system were compared with culture and sensitivity data for the same samples to determine accuracy of the new system. In addition, time to optimal therapy for each patient was calculated as the interval between the initiation of empiric and terminal therapies. The appropriateness of antimicrobial treatment was characterized as guideline-concordant, nonconcordant with the guidelines, or nonconcordant yet still clinically appropriate. Results: In total, 98 and 99 patients met the inclusion criteria before and after implementation of the PCR-based diagnostic system, respectively. PCR-based results displayed 99.8% concordance (440/441 total samples) with results from culture and sensitivity testing. The time to optimal therapy was significantly shorter after implementation, by a mean of 22.8 h (p < 0.001). Overall, 97% of empiric and 99% of terminal antimicrobial regimens were either guideline-concordant or clinically appropriate for treatment of S. aureus bacteremia; 3% of empiric and 1% of terminal antimicrobial regimens were nonconcordant with clinical guidelines without any explanation based on other clinical considerations. Conclusions: The study findings support the utility of using a direct-from-positive-blood-culture PCR-based diagnostic tool as the primary method of identifying S. aureus bacteremia in patients, as well as the acceptance of and acting upon the new assay’s results by our local clinicians. PCR-based assays can help reduce the time to optimal terminal therapy for patients with bacteremia. RESUME Contexte : La bacteriemie a Staphylococcus aureus (BAC-SA), qui est l’une des infections du sang les plus repandues dans le monde, fait peser une lourde charge sur les soins de sante. La mise en place d’un test diagnostique genetique rapide pourrait avoir des retombees importantes sur la gestion clinique des patients presentant une BAC-SA. Objectifs : L’objectif principal consistait a evaluer la concordance entre les tests bases sur la reaction en chaine par polymerase (PCR) et le test de sensibilite et de culture, qui est la reference absolue actuelle; l’objectif secondaire consistait a evaluer l’impact de cette technologie sur les soins des patients. Methodes : Un examen retrospectif des dossiers pre- et post-intervention a servi a decrire le sejour a l’hopital des patients ayant recu un diagnostic de BAC-SA avant et apres la mise en place du systeme de diagnostic de la PCR. Les resultats de laboratoire de tous les echantillons des patients soumis a une analyse de la PCR a la suite de la mise en place de ce systeme ont ete compares avec les donnees relatives a la culture et a la sensibilite de ces memes echantillons afin de determiner la precision du nouveau systeme. De plus, l’evaluation du delai d’atteinte du traitement optimal de chaque patient repose sur le calcul de l’intervalle entre le debut des therapies empiriques et terminales. La pertinence du traitement antimicrobien etait caracterisee comme suit : concordance avec les lignes directrices, non-concordance avec les lignes directrices ou non-concordance mais encore approprie d’un point de vue clinique. Resultats : Au total, 98 et 99 patients ont satisfait au critere d’inclusion respectivement avant et apres la mise en place du systeme de diagnostic de la PCR. Les resultats bases sur la PCR affichaient une concordance de 99,8 % (440/441 echantillons au total) avec les resultats des tests de sensibilite et de culture. La diminution du delai d’atteinte du traitement optimal etait importante apres la mise en place du systeme, puisqu’elle atteignait en moyenne 22,8 h (p < 0,001). De maniere generale, 97 % des regimes antimicrobiens empiriques et 99 % des regimes antimicrobiens terminaux concordaient avec les lignes directrices ou etaient cliniquement appropries pour le traitement de la BAC-SA; 3 % des regimes antimicrobiens empiriques et 1 % des regimes antimicrobiens terminaux n’etaient pas conformes aux lignes directrices cliniques sans qu’aucune explication basee sur d’autres considerations cliniques n’ait ete donnee. Conclusions : Les resultats de l’etude confirment la necessite d’utiliser un outil diagnostique base sur la PCR directement de l’hemoculture positive en guise de methode principale pour determiner la presence de BAC-SA chez les patients ainsi que l’acceptation et l’utilisation des nouveaux resultats du test par nos cliniciens locaux. Les tests bases sur la PCR peuvent aider a reduire le delai d’attente du traitement optimal pour les patients atteints de BAC-SA.

Diagnostic Challenges with Acyclovir Crystalluria - A Case Study.

Abstract: Background/objective Marked to abundant crystalluria may cause significant morbidity due to acute renal injury Intravenous acyclovir administration may result in a pathologic crystalluria, especially in cases with increased renal concentration of the drug It is important that clinical laboratory staff recognize and communicate the presence of abundant crystalluria to clinical staff to avoid irreversible kidney injury Methods We report a case of crystalluria in a patient treated empirically with intravenous acyclovir for possible viral meningitis Results Opaque "milky" urine was submitted for urine analysis which showed abundant long needle-shaped brightly birefringent crystals under polarized light microscopy and was diagnosed as acyclovir crystalluria Conclusions Any case of moderate to abundant crystalluria should be reported in a timely manner to the clinical staff to facilitate treatment modification to reduce the risk of acute kidney injury Laboratory staff should be aware and recognize acyclovir treatment as a possible cause of pathologic crystalluria