Publications by authors named "Daniel Mcisaac"

Climate change is a public health emergency, yet planetary health education is absent for many medical and health professions trainees. To perform a scoping review exploring the inclusion of planetary health in undergraduate and graduate medical education. A search strategy was developed with a health sciences librarian and run on 6 databases from their inception to February 2022: MEDLINE, Embase, APA PsycInfo, CINAHL, Global Health, and Scopus.

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Background: Days at home after surgery is a promising new patient-centred outcome metric that measures time spent outside of healthcare institutions and mortality. The aim of this scoping review was to synthesize the use of days at home in perioperative research and evaluate how it has been termed, defined, and validated, with a view to inform future use.

Methods: The search was run on MEDLINE, Embase, and Scopus on 30 March 2023 to capture all perioperative research where days at home or equivalent was measured.

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Purpose: Postoperative prognostic tools allow for improved prediction of future recurrence risk, patient counseling, and assessment of eligibility for adjuvant treatments and ensure appropriate follow-up surveillance. The purpose of this analysis was to validate existing prognostic models for patients with kidney cancer.

Materials And Methods: The Canadian Kidney Cancer information system is a prospective cohort of patients managed at 14 institutions since January 1, 2011, to present.

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Introduction: Home-based, virtually-supported care models may represent the most efficient and scalable approach to delivering prehabilitation services. However, virtual approaches to prehabilitation are understudied. This manuscript describes the protocol for an internal pilot randomised controlled trial of a virtually-delivered, multimodal prehabilitation intervention.

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Aquatic habitats in urban environments are exposed to complex contaminant mixtures that may harm aquatic biota. The impact of contaminant transfer from contaminated biofilm through aquatic food webs is still understudied, as is the current state of knowledge on dietary exposure of urban contaminants to biota residing in stormwater ponds. Our overall objective was to characterize urban pesticide accumulation in a common aquatic food source (biofilm) in stormwater ponds and to investigate the potential toxicity of that food source by testing the responses of two freshwater macroinvertebrates to experimental exposure.

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Purpose: Northern Ontario residents experience multiple health disparities compared with those in Southern Ontario. It is unknown whether this leads to differences in surgical outcomes. We sought to compare postoperative outcomes of patients from Northern and Southern Ontario.

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Purpose: While there is limited patient-centred evidence (i.e., evidence that is important for patients and end-users) to inform the use of pharmacologic opioid minimization strategies (i.

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  • Regulatory applications for cell therapies face more objections than traditional drugs, primarily due to inadequacies in preclinical evidence like study design and animal model selection, causing delays in approvals.
  • A scoping review of 1215 documents from major regulatory agencies identified 182 relevant papers, highlighting the critical role of understanding the mechanism of action in preclinical studies.
  • While most guidelines stressed using clinically relevant preclinical models and intervention parameters, there were fewer specific recommendations on disease models and proper study designs like randomization and blinding.
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Objectives: Although surgical site infection (SSI) is a commonly used quality metric after lower-limb revascularization surgery, outcomes associated with development of this complication are poorly characterized. We conducted a systematic review and meta-analysis of studies reporting associations between development of an SSI after these procedures and clinical outcomes and healthcare resource use.

Methods: We searched MEDLINE, Embase, CENTRAL, and Evidence-Based Medicine Reviews (inception to April 4th, 2023) for studies examining adjusted associations between development of an SSI after lower-limb revascularization surgery and clinical outcomes and healthcare resource use.

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  • Patients undergoing open radical cystectomy have a high risk of needing blood transfusions, and the study investigates the use of tranexamic acid (TXA) to potentially reduce this risk.
  • The TACT trial was a randomized, double-blind study conducted in 10 academic centers from 2013 to 2021, involving patients scheduled for this type of surgery due to bladder cancer.
  • Results showed no significant difference in RBC transfusion rates between the TXA group and the placebo group, with both groups needing transfusions at similar rates up to 30 days post-surgery.
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  • The study focused on whether a home-based exercise program combined with nutritional guidance (prehabilitation) improves disease-free survival and return to treatment for older cancer patients with frailty compared to usual care.* -
  • Out of 204 participants, results showed that the prehabilitation group and control group had similar rates of death or cancer recurrence (11% each), and slightly more patients returned to treatment in the prehabilitation group (29% vs. 23%).* -
  • Ultimately, the research found no significant advantage of exercise prehabilitation on disease-free survival or treatment return, suggesting that future studies may need to be larger to detect meaningful effects.*
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  • Frailty in elderly patients is linked to higher rates of morbidity and mortality post-surgery, and its relationship with decisional regret (the feeling of regret about undergoing surgery) is not well understood.
  • A study of 669 patients aged 65 and older undergoing elective noncardiac surgery found that 43.8% lived with frailty, and while frailty was initially related to increased decisional regret one year after surgery, this association weakened after adjusting for other factors like age, sex, and mental health.
  • The results indicated that the type of surgery may influence the relationship between frailty and decisional regret, suggesting that more research is needed to fully understand these connections.
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Objective: Multiple strategies exist to facilitate microdissection and obliteration of intracranial aneurysms during microsurgical clipping. Rapid ventricular pacing (RVP) can be used to induce controlled transient hypotension to facilitate aneurysm manipulation. We report the indications and outcomes of intraoperative RVP for clipping of ruptured and unruptured complex aneurysms.

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Background: Cardiogenic shock due to acute myocardial infarction (AMI-CS) is associated with significant short- and long-term morbidity and mortality. Despite this, little is known about associated cost.

Objectives: The purpose of this study was to evaluate the health care costs and resource use associated with AMI-CS using administrative data from the province of Ontario, Canada.

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  • Dexmedetomidine is being increasingly used in surgeries involving general anesthesia, but its impact on patient outcomes needs further evaluation.
  • A systematic review of 44 randomized controlled trials with nearly 5904 participants indicated that intraoperative dexmedetomidine significantly improved recovery quality after surgery.
  • The study found a 99% likelihood of any benefit from its use and an 88% chance of achieving a meaningful improvement in recovery, along with a reduction in chronic pain incidence.
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  • The study examines sex-based differences in the evaluation and management of late-onset hypertension among older adults in Ontario, Canada.
  • It finds that females and males had similar rates of guideline-recommended investigations and medication prescriptions, indicating no significant disparities in initial hypertension management.
  • The research suggests that there are likely no meaningful differences between the sexes in the initial management of late-onset hypertension, which may not explain the observed cardiovascular outcome disparities between genders.
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Background: Patient safety learning systems play a critical role in supporting safety culture in healthcare organisations. A lack of explicit standards leads to inconsistent implementation across organisations, causing uncertainty about their roles and impact. Organisations can address inconsistent implementation by using a self-assessment tool based on agreed-on best practices.

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Introduction: Tranexamic acid (TXA) is an inexpensive and widely available medication that reduces blood loss and red blood cell (RBC) transfusion in cardiac and orthopaedic surgeries. While the use of TXA in these surgeries is routine, its efficacy and safety in other surgeries, including oncologic surgeries, with comparable rates of transfusion are uncertain. Our primary objective is to evaluate whether a hospital-level policy implementation of routine TXA use in patients undergoing major non-cardiac surgery reduces RBC transfusion without increasing thrombotic risk.

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  • * A multicenter clinical trial called PLAN will study the effects of intravenous lidocaine versus a placebo in over 1,600 patients undergoing breast cancer surgery, measuring outcomes like persistent pain incidence and opioid use at various time points post-surgery.
  • * If successful, the trial could establish lidocaine infusion as a standard treatment to reduce chronic pain and opioid reliance in breast cancer patients, potentially lowering healthcare costs and improving overall patient well-being.
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