Association Between CT With Angiography and 30-Day Risk of Stroke or Transient Ischemic Attack in a Canadian Emergency Department Setting.

Introduction: A subset of undifferentiated vertigo cases can be attributed to dangerous central causes such as posterior circulation ischemic stroke (PCIS) or transient ischemic attack (TIA). Due to a lack of validated clinical risk scoring tools, there is currently high heterogeneity in emergency department (ED) neuroimaging practices for patients presenting with undifferentiated vertigo. Therefore, this study assessed the utility of head and neck CT with angiography (CTA) for risk stratifying ED patients presenting with vertigo.

Metabolomic Insights into COVID-19 Severity: A Scoping Review.

Background: In 2019, SARS-CoV-2, the novel coronavirus, entered the world scene, presenting a global health crisis with a broad spectrum of clinical manifestations. Recognizing the significance of metabolomics as the omics closest to symptomatology, it has become a useful tool for predicting clinical outcomes. Several metabolomic studies have indicated variations in the metabolome corresponding to different disease severities, highlighting the potential of metabolomics to unravel crucial insights into the pathophysiology of SARS-CoV-2 infection.

Endotyping in ARDS: one step forward in precision medicine.

Background: The Berlin definition of acute respiratory distress syndrome (ARDS) includes only clinical characteristics. Understanding unique patient pathobiology may allow personalized treatment. We aimed to define and describe ARDS phenotypes/endotypes combining clinical and pathophysiologic parameters from a Canadian ARDS cohort.

Metabolomics in severe traumatic brain injury: a scoping review.

Background: Diagnosis and prognostication of severe traumatic brain injury (sTBI) continue to be problematic despite years of research efforts. There are currently no clinically reliable biomarkers, though advances in protein biomarkers are being made. Utilizing Omics technology, particularly metabolomics, may provide new diagnostic biomarkers for sTBI.

Deliberate practice of diagnostic clinical reasoning reveals low performance and improvement of diagnostic justification in pre-clerkship students.

Purpose: Diagnostic errors are a large burden on patient safety and improving clinical reasoning (CR) education could contribute to reducing these errors. To this end, calls have been made to implement CR training as early as the first year of medical school. However, much is still unknown about pre-clerkship students' reasoning processes.

Using metabolomics to predict severe traumatic brain injury outcome (GOSE) at 3 and 12 months.

Background: Prognostication is very important to clinicians and families during the early management of severe traumatic brain injury (sTBI), however, there are no gold standard biomarkers to determine prognosis in sTBI. As has been demonstrated in several diseases, early measurement of serum metabolomic profiles can be used as sensitive and specific biomarkers to predict outcomes.

Methods: We prospectively enrolled 59 adults with sTBI (Glasgow coma scale, GCS ≤ 8) in a multicenter Canadian TBI (CanTBI) study.

Opioid-related emergency department visits and deaths after a harm-reduction intervention: a retrospective observational cohort time series analysis.

Background: To date, there has been little research on the effect of safe consumption site and community-based naloxone programs on regional opioid-related emergency department visits and deaths. We sought to determine the impact of these interventions on regional opioid-related emergency department visit and death rates in the province of Alberta.

Methods: We used a retrospective observational design, via interrupted time series analysis, to assess municipal opioid-related emergency department visit volume and opioid-related deaths (defined by poisoning and opioid use disorder).

Effects of music therapy on mood, pain, and satisfaction in the neurologic inpatient setting.

Purpose: Music therapy (MT) has been used in health care settings for a wide variety of treatment goals. Many inpatients with neurologic impairments struggle with low mood and pain for which MT may be a novel adjunct treatment. The aims of this study were to: (1) evaluate change in mood and pain following a single MT session; (2) explore the impact of an MT program on mood, pain and satisfaction from the perspective of the patient, family and staff.

Effectiveness of intravenous prostaglandin to reduce digital amputations from frostbite: an observational study.

Purpose: We assessed the effectiveness and safety of a 5-day intravenous prostaglandin (iloprost) protocol at reducing digital amputation for patients with severe frostbite injuries at urban emergency departments.

Methods: This retrospective study examines consecutive patients who presented to Calgary emergency departments from April 2017 to April 2020 with Grade 2-4 frostbite injuries. Patients from February 2019 onward were managed using a 5-day iloprost infusion protocol, whereas patients prior to this time were managed with standard care (local best practice without iloprost as a therapeutic option).

Development and Pilot Testing of a Data-Rich Clinical Reasoning Training and Assessment Tool.

Problem: Clinical reasoning is a core competency for physicians and also a common source of errors, driving high rates of misdiagnoses and patient harm. Efforts to provide training in and assessment of clinical reasoning skills have proven challenging because they are either labor- and resource-prohibitive or lack important data relevant to clinical reasoning. The authors report on the creation and use of online simulation cases to train and assess clinical reasoning skills among medical students.

Sedation strategy and ICU delirium: a multicentre, population-based propensity score-matched cohort study.

Objectives: We examined the relationship between dominant sedation strategy, risk of delirium and patient-centred outcomes in adults admitted to intensive care units (ICUs).

Design: Retrospective propensity-matched cohort study.

Setting: Mechanically ventilated adults (≥ 18 years) admitted to four Canadian hospital medical/surgical ICUs from 2014 to 2016 in Calgary, Alberta, Canada.

Understanding Home Hemodialysis Patient Attrition: A Cohort Study.

Background: Home hemodialysis (HHD) offers a flexible, patient-centered modality for patients with kidney failure. Growth in HHD is achieved by increasing the number of patients starting HHD and reducing attrition with strategies to prevent the modifiable reasons for loss.

Objective: Our primary objective was to describe a Canadian HHD population in terms of technique failure and time to exit from HHD in order to understand reasons for exit.

ARDS metabolic fingerprints: characterization, benchmarking, and potential mechanistic interpretation.

In this study, we aimed to identify acute respiratory distress syndrome (ARDS) metabolic fingerprints in selected patient cohorts and compare the metabolic profiles of direct versus indirect ARDS and hypoinflammatory versus hyperinflammatory ARDS. We hypothesized that the biological and inflammatory processes in ARDS would manifest as unique metabolomic fingerprints that set ARDS apart from other intensive care unit (ICU) conditions and could help examine ARDS subphenotypes and clinical subgroups. Patients with ARDS ( = 108) and ICU ventilated controls ( = 27) were included.

Interactions between serum FSH, inhibin B and antral follicle count in the decline of serum AMH during the menstrual cycle in late reproductive age.

Objective: To investigate the hormonal interrelationships during the menstrual cycle in women of late reproductive age with suppressed serum AMH and antral follicle count (AFC).

Methods: Serum hormones (AMH, FSH, LH, estradiol, progesterone, inhibin A, inhibin B), AFC (2-10 mm) and AMH/AFC ratio (an estimate of AMH/follicle) were assessed every 2-3 days across the menstrual cycle in 26 healthy ovulatory women aged 18-50 years.

Results: An 11-fold fall in AMH/AFC was observed in women aged ≥45 years compared to those 18-45 years ( < .

Quantifying the medical student learning curve for ECG rhythm strip interpretation using deliberate practice.

Obtaining competency in medical skills such as interpretation of electrocardiograms (ECGs) requires repeated practice and feedback. Structured repeated practice and feedback for ECGs is likely not provided to most medical students, so skill development is dependent on opportunistic training during clinical rotations. Our aim was to describe: the amount of deliberate practice completed for learning ECG rhythm strip diagnoses in first year medical students, the learning curve for rhythm strip diagnosis, and student experiences with deliberate practice.

Age-related changes in luteal dynamics: preliminary associations with antral follicular dynamics and hormone production during the human menstrual cycle.

Objective: The aim of the study was to test the hypothesis that the development of luteal phase dominant follicles (LPDFs) as women age is associated with abnormal luteal function.

Methods: Luteal and antral follicle diameter were quantified in ovulatory women of midreproductive age (MRA; 18-35 y; n = 9) and advanced reproductive age (ARA; 45-55 y; n = 16) every 1 to 3 days during one complete interovulatory interval. Blood was drawn at each visit and assayed for progesterone, estradiol, inhibin A, follicle-stimulating hormone, and luteinizing hormone.

Trajectories of pain severity in juvenile idiopathic arthritis: results from the Research in Arthritis in Canadian Children Emphasizing Outcomes cohort.

We studied children enrolled within 90 days of juvenile idiopathic arthritis diagnosis in the Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh-Out) prospective inception cohort to identify longitudinal trajectories of pain severity and features that may predict pain trajectory at diagnosis. A total of 1062 participants were followed a median of 24.3 months (interquartile range = 16.

The Effect of Extrinsic Material and Radiation Dose on Model-Based Iterative Reconstruction Chest Computed Tomography Reconstruction Time: A Phantom-Based Study.

Objective: Compare effect of extrinsic materials and radiation dose levels on image processing times for model-based iterative reconstruction (MBIR) in computed tomography.

Methods: Chest computed tomography scans were performed on a phantom with three different levels of clothing and medical equipment at three tube current settings to reflect differing radiation doses. Reconstruction time for MBIR was recorded, and objective image quality was assessed via noise within the phantom mediastinum.

Trajectories of Life Satisfaction and their Predictors among Korean Older Adults.

Background: Among older adults, life satisfaction (LS) correlates with health, mortality, and successful ageing. As various potential threats to LS tend to increase with advancing years, patterns of age-related changes in LS among older adults remain inconsistent. This study aimed to identify LS trajectories in older adults and the characteristics of individuals who experience them.

Interrelationships among reproductive hormones and antral follicle count in human menstrual cycles.

It is recognised that ovarian factors, including steroid and protein hormones, are critical in the feedback regulation of pituitary gonadotropins; however, their individual contributions are less defined. The aim of this study was to explore the reciprocal relationships between ovarian and pituitary hormones across the normal ovulatory menstrual cycle as women age. FSH, LH, oestradiol, progesterone, inhibin A, inhibin B and anti-mullerian hormone (AMH) were measured in serum collected every 1-3 days across one interovulatory interval (IOI) from 26 healthy women aged 18-50 years.

A Clinical Randomized Trial Comparing the Cycloplegic Effect of Cyclopentolate Drops Applied to Closed Eyelids Versus Open Eyelids.

Background And Purpose: Adequate cycloplegia and dilation are required for refraction and fundus exam in children. Standard practice is to instill cycloplegic drops in the inferior cul-de-sac, and this is often traumatic for children. Our study assesses the use of cyclopentolate on closed lids as a method of instillation for ensuring complete cycloplegia.