Hospital antimicrobial stewardship funding and resourcing impact on broad-spectrum antibiotic use: a cross-sectional study.

Background: Antimicrobial stewardship programs (ASPs) aim to mitigate antimicrobial resistance (AMR) by optimizing antibiotic use including reducing unnecessary broad-spectrum therapy. This study evaluates the impact of ASP funding and resources on the use of broad-spectrum antibiotics in Ontario hospitals.

Methods: We conducted a cross-sectional study of antimicrobial use (AMU) across 63 Ontario hospitals from April 2020 to March 2023.

Serotype Distribution Among US Adults Hospitalized With Community-Acquired Pneumonia, 2019-2020.

Background: Serotype-specific urinary antigen detection (UAD) assay results can be used to estimate the serotype contribution among adults with pneumococcal community-acquired pneumonia (CAP) and to guide recommendations regarding higher-valency pneumococcal conjugate vaccines (PCVs).

Methods: Adults aged ≥18 years hospitalized with radiographic evidence of CAP were prospectively enrolled in 4 US cities from November 2019 to December 2020, overlapping the coronavirus disease 2019 (COVID-19) pandemic. Data were collected by patient interview and medical chart review.

3D CT to 2D X-ray image registration for improved visualization of tibial vessels in endovascular procedures.

Purpose: During endovascular revascularization interventions for peripheral arterial disease, the standard modality of X-ray fluoroscopy (XRF) used for image guidance is limited in visualizing distal segments of infrapopliteal vessels. To enhance visualization of arteries, an image registration technique was developed to align pre-acquired computed tomography (CT) angiography images and to create fusion images highlighting arteries of interest.

Methods: X-ray image metadata capturing the position of the X-ray gantry initializes a multiscale iterative optimization process, which uses a local-variance masked normalized cross-correlation loss to rigidly align a digitally reconstructed radiograph (DRR) of the CT dataset with the target X-ray, using the edges of the fibula and tibia as the basis for alignment.

Preferred labels and language to improve communication about lesions at low risk of progressing to cancer: qualitative interviews with patients and physicians.

Objectives: We explored how to improve communication about low-risk lesions including labels, language and other strategies.

Design: Qualitative description and thematic analysis to examine the transcripts of telephone interviews with patients who had low-risk lesions and physicians; and mapping to Communication Accommodation Theory to interpret themes.

Setting: Canada PARTICIPANTS: 15 patients: 6 (40%) bladder, 5 (33%) prostate and 4 (27%) cervix lesions; and 13 physicians: 7 (54%) cervix, 3 (23%) bladder and 3 (23%) prostate lesions.

International Consensus Guidance for the Management of Glucocorticoid Related Complications in Neuromuscular Disease.

Introduction/aims: Glucocorticoid (GC)-related adverse reactions and risks are commonly seen during the treatment of immune-mediated and inflammatory neuromuscular disorders. There is wide variation in the management of associated complications. The aim of this study is to develop international consensus guidance on the management of GC-related complications in neuromuscular disorders.

Stratifying vascular disease patients into homogeneous subgroups using machine learning and FLAIR MRI biomarkers.

This study proposes a framework to stratify vascular disease patients based on brain health and cerebrovascular disease (CVD) risk using regional FLAIR biomarkers. Intensity and texture biomarkers were extracted from FLAIR volumes of 379 atherosclerosis patients. K-Means clustering identified five homogeneous subgroups.

Identifying mild traumatic brain injury in the post-acute polytrauma setting: a scoping review of diagnostic approaches and screening tools.

Objective: Mild traumatic brain injury (mTBI) is frequently overlooked in polytrauma patients due to the overshadowing of more severe injuries, a fact that makes its identification in post-acute settings challenging since symptoms overlap with other conditions and no validated diagnostic tools exist. To address this gap, this scoping review explored the literature on mTBI diagnosis in post-acute civilian polytrauma settings.

Methods: By utilizing the Arksey and O'Malley framework and PRISMA-ScR guidelines, the review focused on studies from 2010 to 2024 related to delayed mTBI diagnosis in adults.

Comparison of Renal Adverse Events Between Intravitreal Anti-Vascular Endothelial Growth Factor Agents: A Meta-Analysis.

Purpose: To assess the risk of renal adverse events, particularly acute kidney injury (AKI), between intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents.

Design: Meta-analysis.

Methods: A systematic literature search was conducted on Ovid Medline, Embase and the Cochrane Library for randomized controlled trials (RCTs) published from January 2005 to February 2024 involving adult patients receiving anti-VEGF intravitreal injections for agerelated macular degeneration, diabetic macular edema, and macular edema secondary to retinal vein occlusion.

Cost-Effectiveness of Breast Cancer Screening Using Digital Mammography in Canada.

Importance: Evolving breast cancer treatments have led to improved outcomes but carry a substantial financial burden. The association of treatment costs with the cost-effectiveness of screening mammography is unknown.

Objective: To determine the cost-effectiveness of population-based breast cancer screening in the context of current treatment standards.

Outcomes among patients with coronary artery bypass grafts presenting with acute coronary syndrome: impact of revascularization.

Background: Patients post-coronary artery bypass graft (CABG) can re-present with acute coronary syndrome (ACS); however, culprit lesion identification, as well as revascularization, is often challenging. Furthermore, the impact of revascularization in this patient group is relatively unknown.

Objectives: The purpose of our study was to evaluate the efficacy of percutaneous coronary intervention (PCI) in patients with previous CABG surgery presenting with ACS.

Delayed Postoperative Radiotherapy in Head & Neck Cancers-A Systematic Review and Meta-Analysis.

Objectives: To evaluate the impact of delayed postoperative radiotherapy (PORT) on overall survival (OS) in patients with head and neck cancers (HNC).

Data Sources: A systematic review and meta-analysis were conducted by searching MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases.

Review Methods: Studies assessing the impact of delayed PORT in adult HNC patients were included.

Intraosseous and intravenous vascular access during adult cardiac arrest: a systematic review and meta-analysis.

Objective: To summarise evidence on the clinical effectiveness of initial vascular attempts via the intraosseous route compared to the intravenous route in adult cardiac arrest.

Methods: We searched MEDLINE and Embase (OVID platform), the Cochrane library, and the International Clinical Trials Registry Platform from inception to September 4 2024 for randomised clinical trials comparing the intraosseous route with the intravenous route in adult cardiac arrest. Our primary outcome was 30-day survival.

Predefined and data-driven CT radiomics predict recurrence-free and overall survival in patients with pulmonary metastases treated with stereotactic body radiotherapy.

Background: This retrospective study explores two radiomics methods combined with other clinical variables for predicting recurrence free survival (RFS) and overall survival (OS) in patients with pulmonary metastases treated with stereotactic body radiotherapy (SBRT).

Methods: 111 patients with 163 metastases treated with SBRT were included with a median follow-up time of 927 days. First-order radiomic features were extracted using two methods: 2D CT texture analysis (CTTA) using TexRAD software, and a data-driven technique: functional principal components analysis (FPCA) using segmented tumoral and peri-tumoural 3D regions.

The association between neighbourhood marginalization and SARS-CoV-2 outcomes in patients presenting to emergency departments.

Objective: Social and economic marginalizations have been associated with inferior health outcomes in Canada. Our objective was to describe the relationship between neighbourhood marginalization and COVID-19 outcomes among patients presenting to Canadian emergency departments (ED).

Methods: We conducted an observational study among consecutive COVID-19 patients recruited from 47 hospitals participating in the Canadian COVID-19 ED Rapid Response Network (CCEDRRN) between March 3, 2020, and July 24, 2022.

Transfabric Leaks After Percutaneous Left Atrial Appendage Occlusion Procedures with the WATCHMAN FLX Device.

Background: Cardiac computed tomography imaging with contrast is being used increasingly to image left atrial appendage occlusion (LAAO) devices. Contrast flow across a device, also known as a transfabric leak (TFL), may indicate a lack of complete LAAO-device endothelialization. The data on the rate, predictors, and clinical events associated with TFL are limited.

Primary care follow-up improves outcomes in older adults following emergency general surgery admission.

Background: While preoperative optimization improves outcomes for older adults undergoing major elective surgery, no such optimization is possible in the emergent setting. Surgeons must identify postoperative interventions to improve outcomes among older emergency general surgery (EGS) patients. The objective of this cohort study was to examine the association between early follow-up with a primary care physician (PCP) and the risk of nursing home acceptance or death in the year following EGS admission among older adults.

Accelerated growth and local progression of radiorecurrent prostate cancer in an orthotopic bioluminescent mouse model.

Globally, prostate cancer is the second most common malignancy in males, with over 400 thousand men dying from the disease each year. A common treatment modality for localized prostate cancer is radiotherapy. However, up to half of high-risk patients can relapse with radiorecurrent prostate cancer, the aggressive clinical progression of which remains severely understudied.

Towards a histological diagnosis of childhood small vessel CNS vasculitis.

Background: Primary small vessel CNS vasculitis (sv-cPACNS) is a challenging inflammatory brain disease in children. Brain biopsy is mandatory to confirm the diagnosis. This study aims to develop and validate a histological scoring tool for diagnosing small vessel CNS vasculitis.

A Remote Management-Centric Post-Discharge Pathway for Patients Admitted to GIM with Heart Failure.

Background: Few GIM-specific heart failure transition of care (TOC) programs exist. We thus piloted a TOC program for heart failure patients discharged from GIM that incorporates a remote patient management program, Medly.

Methods: This single-centre, prospective proof-of-concept study described sociodemographic and medical characteristics of included patients, and computed summary statistics to describe clinical and workload outcomes.

Development of a National Colorectal Cancer Screening Research Agenda: An Initiative of the Canadian Screening for Colorectal Cancer Research Network (CanSCCRN).

The Canadian Screening for Colorectal Cancer Research Network (CanSCCRN) recently set out to develop a national CRC screening research agenda and identify priority research areas. The specific objectives were to (1) identify evidence gaps relevant to CRC screening and the barriers and facilitators to evidence generation and uptake by CRC screening programs, (2) establish high-priority collaborative research ideas to inform best CRC screening practices, and (3) identify one to two research topics for grant development and submission within 12 to 18 months. Three focus groups were conducted with network members and relevant parties ( = 15) to identify evidence gaps, barriers, and facilitators to evidence generation and uptake.

Management of Ductal Carcinoma In Situ: An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline.

(1) Background: To make recommendations on the most effective therapy options for Ductal Carcinoma of the Breast (DCIS) patients; (2) Methods: MEDLINE, EMBASE, Cochrane Library, PROSPERO databases, and main relevant guideline websites were searched. Draft versions of the guideline went through formal internal and external reviews, with a final approval by the Program in Evidence Based Care and the DCIS Expert Panel. The Grading of Recommendations, Assessment, Development, and Evaluation approach was followed; (3) Results: Based on the current evidence from the systematic review and this guideline authors' clinical opinions, initial draft recommendations were developed to improve the management of patients with DCIS.

A Randomized Control Trial of a Virtually Delivered Program for Increasing Upper Limb Activity After Stroke.

Background: Upper limb activity following stroke is low, which may limit recovery. We investigated whether a virtually-delivered upper limb program, that included a wearable device with reach-to-grasp feedback, would increase upper limb activity after stroke.

Methods: This was a parallel-group, assessor-blinded, randomized control trial conducted at 6 sites across 5 provinces of the CanStroke Recovery Trials Platform between 2020 to 2022.