Breaking Down Bias: A Methodological Primer on Identifying, Evaluating, and Mitigating Bias in Cardiovascular Research.

Systematic error, often referred to as bias is an inherent challenge in observational cardiovascular research, and has the potential to profoundly influence the design, conduct, and interpretation of study results. If not carefully considered and managed, bias can lead to spurious results, which can misinform clinical practice or public health initiatives and compromise patient outcomes. This methodological primer offers a concise introduction to the identification, evaluation, and mitigation of bias in observational cardiovascular research studies assessing the causal association of an exposure (or treatment) on an outcome.

Comparing Interfractional Stability of Heart Dose Among Three Breath-Hold Radiotherapy Techniques in Breast Cancer.

Aims: Breath holding can reduce the cardiac dose in radiotherapy for left-sided breast cancer. We evaluated whether any of the existing commonly used breath-hold techniques was superior in maintaining a more reproducible mean heart dose (MHD) during treatment.

Materials And Methods: This was a single-institution, interventional, nonrandomised, three-armed prospective trial, comparing the reproducibility of MHD in breath-hold radiotherapy using voluntary deep inspiration breath hold (vDIBH), active breathing control (ABC), and surface-guided radiotherapy (SGRT).

Cerebral spinal fluid analyses and therapeutic implications for leptomeningeal metastatic disease.

Purpose: To review applications of cerebral spinal fluid (CSF) biomarkers for the diagnosis, monitoring and treatment of leptomeningeal metastatic disease (LMD) among patients with metastatic solid tumors.

Methods: A narrative review identified original research related to CSF biomarkers among patients with metastatic solid tumors and LMD. Pre-clinical research (e.

Neuromodulation as a therapeutic approach for post-traumatic stress disorder: the evidence to date.

Introduction: Post-traumatic stress disorder (PTSD) can have debilitating effects on quality of life, and conventional treatments show mixed results. Neuromodulation is emerging as a promising approach for treating PTSD. This review examines current neuromodulatory treatments for PTSD, and highlights methodologies, clinical outcomes, and gaps in the literature to help guide future research.

Safety and Efficacy of Intravenous Thrombolysis by Infarct Type in Patients with No Visible Occlusion: A Secondary Analysis of the AcT Trial.

Background: About 25% of patients with acute ischemic stroke have lacunar infarct on follow-up imaging. In this secondary analysis from the AcT (Alteplase Compared With Tenecteplase) trial, we assessed if there is variation in safety or efficacy of intravenous thrombolysis by infarct type in patients with no visible occlusion. We also determined if this effect differed between tenecteplase and alteplase.

Turbulence in the system: Higher rates of left-without-being-seen emergency department visits and associations with increased risks of adverse patient outcomes since 2020.

Objective: To examine risks of severe adverse patient outcomes shortly after a left-without-being-seen emergency department (LWBS ED) visit since 2020.

Methods: In this retrospective study using linked administrative data, we examined temporal trends in monthly rates of ED and LWBS visits for adults in Ontario, Canada, 2014‒2023. In patient-level analyses restricted to the first eligible LWBS ED visit, we used modified Poisson regression to compare the composite outcome of 7-day all-cause mortality or hospitalization following a LWBS ED visit for April 1, 2022‒March 31, 2023 (recent period) to April 1, 2014‒March 31, 2020 (baseline period), adjusted for age, sex, and Charlson comorbidity index.

Long-term Risk of Infection Among Patients Colonized With Antimicrobial-Resistant Pathogens: A Population-wide Cohort Study.

Background: Antimicrobial-resistant (AMR) pathogens represent an ongoing global health burden. Colonization is often a prerequisite for infection, but the risk of infection after AMR colonization is not well understood. Using population-level health administrative data, we sought to investigate the risk of infection with the same AMR organism after detection of colonization.

SARS-CoV-2 Illumina GeNome Assembly Line (SIGNAL), a Snakemate workflow for rapid and bulk analysis of Illumina sequencing of SARS-CoV-2 genomes.

The incorporation of sequencing technologies in frontline and public health healthcare settings was vital in developing virus surveillance programs during the Coronavirus Disease 2019 (COVID-19) pandemic caused by transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, increased data acquisition poses challenges for both rapid and accurate analyses. To overcome these hurdles, we developed the SARS-CoV-2 Illumina GeNome Assembly Line (SIGNAL) for quick bulk analyses of Illumina short-read sequencing data.

Patient-reported Outcome Measures for Peripheral Nerve Injuries: A Systematic Review.

Background: The goal of managing patients with peripheral nerve injuries is to improve how a patient feels and functions. This goal is best assessed with patient-reported outcome measures (PROMs), which elicit patient concerns, treatment goals, and clinical progression. This study reviews existing PROMs for adult patients with peripheral nerve injuries to assess how comprehensively they measure outcomes important to patients.

Consensus Radiation Treatment Planning Guidelines Using (68)Ga-DOTATATE PET/CT For Resected Meningiomas.

Purpose: Meningiomas are the most common primary intracranial tumor. Somatostatin receptor 2 is almost universally expressed in meningioma tissue. For patients who require adjuvant radiation, somatostatin receptor based (68)Ga-DOTATATE positron emission tomography (PET) imaging can detect additional or residual disease not discernible on magnetic resonance imaging.

Extracorporeal membrane oxygenation for patients with electrical storm or refractory ventricular arrhythmias: Management and outcomes.

Patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are at high risk for ventricular arrhythmias due to derangements in myocardial perfusion, hemodynamics, and heightened catecholamine states. Existing data on the management and outcomes of patients with electrical storm or refractory ventricular tachycardia/fibrillation (VT/VF) treated with VA-ECMO are primarily derived from retrospective observational studies. Typical survival rates are in the range of 40-50%, with 15-20% of patients undergoing VT ablation and 30-40% of patients requiring advanced heart failure therapies (cardiac transplant or durable left ventricular assist device).

The landscape of primary mismatch repair deficient gliomas in children, adolescents, and young adults: a multi-cohort study.

Background: Gliomas are a major cause of cancer-related death among children, adolescents, and young adults (age 0-40 years). Primary mismatch repair deficiency (MMRD) is a pan-cancer mechanism with unique biology and therapeutic opportunities. We aimed to determine the extent and impact of primary MMRD in gliomas among children, adolescents, and young adults.

Precision radiotherapy with molecular-profiling of CNS tumours.

Diagnoses of CNS malignancies in the primary and metastatic setting have significantly advanced in the last decade with the advent of molecular pathology. Using a combination of immunohistochemistry, next-generation sequencing, and methylation profiling integrated with traditional histopathology, patient prognosis and disease characteristics can be understood to a much greater extent. This has recently manifested in predicting response to targeted drug therapies that are redefining management practices of CNS tumours.

Assessing Adherence to the PRISMA-DTA Guideline in Diagnostic Test Accuracy Systematic Reviews: A Five-Year Follow-up Analysis.

Background: We evaluated reporting of diagnostic test accuracy (DTA) systematic reviews using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-DTA and PRISMA-DTA for abstracts.

Methods: We searched MEDLINE for recent DTA systematic reviews (September 2023-Mar 2024) to achieve a sample size of 100. Analyses evaluated adherence to PRISMA-DTA (and abstracts), on a per-item basis.

Leveraging local public health to advance antimicrobial stewardship (AMS) implementation and mitigate antimicrobial resistance (AMR): a scoping review.

Objective: To explore the role of local public health organisations in antimicrobial stewardship (AMS) and antimicrobial resistance (AMR) surveillance.

Methods: A scoping review was conducted. Peer-reviewed and grey literature from countries within the organisation for economic co-operation and development was searched between 1999 and 2023 using the concepts of local public health, AMR and AMS.

Impact of daily prompt to vaccinate inpatients awaiting rehabilitation against SARS-CoV-2 and influenza.

A daily prompt to offer vaccination to inpatients awaiting transfer to rehabilitation resulted in increased SARS-CoV-2 (OR 5.64, 95% CI 3.3-10.

Embedding a culture of research in Canadian community hospitals: a qualitative study.

Background: In Canada, academic hospitals are the principal drivers of research and medical education, while community hospitals provide patient care to a majority of the population. Benefits of increasing community hospital research include improved patient outcomes and access to research, enhanced staff satisfaction and retention and increased research efficiency and generalizability. While the resources required to build Canadian community hospital research capacity have been identified, strategies for strengthening organizational research culture in these settings are not well defined.

A retrospective chart review and thematic analysis of patients seeking mpox vaccination during the initial outbreak in 2022-2023: evaluation of access, motivations, and stigma.

Background: Mpox was identified in many previously non-endemic countries, including Canada, as of May 2022. In response to the increase in cases in Canada, and more specifically the province of Ontario, the vaccine Imvamune was rolled out. Eligibility was governed by provincial health authorities, and the response varied by region.

Factors associated with anxiety and fear of falling in older adults: A rapid systematic review of reviews.

Background: Anxiety disorders are prevalent amongst older adults and negatively impact their quality-of-life and health. Anxiety disorders often go undetected or are misattributed to age-related changes. The aim of this systematic review of reviews, was to synthesize existing evidence on risk factors associated with anxiety in older adults to improve opportunities for early detection and intervention.

Variation in Case Exposure During Internal Medicine Residency.

Importance: Variation in residency case exposure affects resident learning and readiness for future practice. Accurate reporting of case exposure for internal medicine (IM) residents is challenging because feasible and reliable methods for linking patient care to residents are lacking.

Objective: To develop an integrated education-clinical database to characterize and measure case exposure variability among IM residents.

Evidence Versus Frenzy in Robotic Total Knee Arthroplasty: A Systematic Review Comparing News Media Claims to Randomized Controlled Trial Evidence.

Background: Robotic total knee arthroplasty (rTKA) has garnered increasing attention in recent years, both clinically and in the media. The purpose of this study was to compare the volume of and messaging in published randomized controlled trials (RCTs) versus media reports on the topic of rTKA.

Methods: This was a systematic review of RCTs and media articles on rTKA.