409 results match your criteria: "University of Ottawa and the Ottawa Hospital[Affiliation]"

Purpose: Pneumocystis jirovecii pneumonia (PJP) prophylaxis is required by provincial and national drug monographs during glioma treatment using temozolomide (TMZ) concurrently with radiation (TMZ-RT). However, real-world data suggest the potential benefits of PJP prophylaxis may not outweigh its potential harms in this population.

Methods: We conducted a single-center patient survey and a national physician survey to explore the role of PJP prophylaxis amongst glioma patients undergoing TMZ-RT.

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The use of cannabis and cannabis-related products among patients with hidradenitis suppurativa (HS) is increasing globally. Given the potential anti-inflammatory, therapeutic, and pain management benefits of cannabis-related products, we reviewed primary literature to evaluate the prevalence and possible purpose for cannabis use among patients with HS and to provide recommendations to patients and physicians. A narrative review of original studies was conducted using Embase and Ovid Medline databases.

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Effectiveness of dexmedetomidine on patient-centred outcomes in surgical patients: a systematic review and Bayesian meta-analysis.

Br J Anaesth

September 2024

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada; Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.

Article Synopsis
  • 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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Article Synopsis
  • Solid organ transplant recipients are at a significantly higher risk for severe COVID-19 outcomes, with a rate nearly 6 times higher than that of the general population.
  • The study included over 15,000 transplant recipients and highlighted that these patients tend to be younger and have more underlying health issues compared to the general population.
  • Despite a decrease in severe COVID-19 rates over time, ongoing protective measures and resources are essential for this vulnerable group.
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Article Synopsis
  • Pediatric acute otitis media (AOM) is common in children, leading to concerns about overdiagnosis and overtreatment, prompting the need for specific quality indicators (QIs).
  • An expert panel, utilizing the RAND/UCLA methodology, evaluated candidate indicators and ultimately agreed on 8 QIs related to antimicrobial management, referrals, and counseling for tympanostomy tubes.
  • These QIs aim to address the inconsistent care in AOM diagnosis and management, enhancing adherence to guidelines and improving patient outcomes.
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Treatment of renal pruritus with dupilumab monotherapy: A case report.

SAGE Open Med Case Rep

June 2024

Division of Dermatology, Faculty of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.

Chronic kidney disease-associated pruritus leads to decreased quality of life and is an independent risk factor for mortality. There is limited evidence for treatment of chronic kidney disease-associated pruritus, with only one on-label treatment approved by the FDA and Health Canada. We present a case of a 69-year-old female with a history of chronic kidney disease, who presented to clinic with a several-year history of diffuse, intense pruritus.

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While advanced liver disease was previously considered to be an acquired bleeding disorder, there is increasing recognition of an associated prothrombotic state with patients being at higher risk of atrial fibrillation (AF) and stroke and venous thromboembolism (VTE) including portal vein thrombosis (PVT). We review the available literature on epidemiology, pathophysiology, and risk factors and provide guidance on anticoagulant management of these conditions in adults with cirrhosis. In patients with Child-Pugh A or B cirrhosis and AF, we recommend anticoagulation with standard-dose direct oral anticoagulants (DOACs) in accordance with cardiology guideline recommendations for patients without liver disease.

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Melanoma in a congenital melanocytic nevus.

CMAJ

May 2024

Faculty of Medicine (Zeglinski-Spinney, Kirchhof), University of Ottawa; Dermatology Division (Kirchhof), Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, Ont.

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Aim: Acute kidney injury (AKI) increases the risk for progressive chronic kidney disease (CKD). MicroRNA (miR)-486-5p protects against kidney ischemia-reperfusion (IR) injury in mice, although its long-term effects on the vasculature and development of CKD are unknown. We studied whether miR-486-5p would prevent the AKI to CKD transition in rat, and affect vascular function.

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Article Synopsis
  • Early treatment with immunomodulating therapy improves short-term clinical outcomes in multiple sclerosis (MS) patients, reducing the risk of conversion to clinically definite MS (CDMS) by 30.5%.
  • In a study of patients with clinically isolated syndrome (CIS), those who received early treatment demonstrated fewer relapses and maintained stable disability over 15 years compared to a delayed treatment group.
  • By the 15-year mark, 66.3% of patients treated early remained employed, further indicating the benefits of starting treatment early in the disease course.
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  • A study analyzed cardiovascular outcomes in 266,273 older adults (≥66 years) newly diagnosed with hypertension in Ontario, Canada, to understand sex differences.
  • Results showed that women had a lower incidence of major cardiovascular events and mortality compared to men over a median follow-up of 6.6 years.
  • The findings indicate that sex plays a significant role in cardiovascular risks associated with late-onset hypertension, suggesting the need for tailored approaches in diagnosis and treatment for this demographic.
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Article Synopsis
  • The study aimed to assess the incidence and outcomes of emergency general surgery at a Swiss University Hospital, focusing on patient characteristics and how age affects clinical outcomes.
  • A total of 310,914 emergency department visits from 2015 to 2019 were analyzed, with 3,592 patients undergoing surgery within three days of admission, indicating an annual incidence of 116 surgeries per 10,000 visits.
  • Results showed that older patients faced significantly higher risks for ICU admission, dependence at discharge, and one-year mortality compared to younger patients.
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The Second International Consensus Guidelines on the Management of BK Polyomavirus in Kidney Transplantation.

Transplantation

September 2024

Division of Transplantation and Clinical Virology, Department of Biomedicine, Faculty of Medicine, University of Basel, Basel, Switzerland.

BK polyomavirus (BKPyV) remains a significant challenge after kidney transplantation. International experts reviewed current evidence and updated recommendations according to Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Risk factors for BKPyV-DNAemia and biopsy-proven BKPyV-nephropathy include recipient older age, male sex, donor BKPyV-viruria, BKPyV-seropositive donor/-seronegative recipient, tacrolimus, acute rejection, and higher steroid exposure.

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Background: People living with frailty are vulnerable to poor outcomes and incur higher health care costs after coronary artery bypass graft (CABG) surgery. Frailty-defining instruments for population-level research in the CABG setting have not been established. The objectives of the study were to develop a preoperative frailty index for CABG (pFI-C) surgery using Ontario administrative data; assess pFI-C suitability in predicting clinical and economic outcomes; and compare pFI-C predictive capabilities with other indices.

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Background: Cardiac implantable electronic device (CIED) infection is a costly and highly morbid complication. Perioperative interventions, including the use of antibiotic pouches and intensified perioperative antibiotic regimens, have demonstrated marginal efficacy at reducing CIED infection. Additional research is needed to identify additional interventions to reduce infection risk.

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Article Synopsis
  • - The study aimed to categorize nonclinical and behavioral factors that influence intraoperative red blood cell (RBC) transfusion practices using the theoretical domains framework (TDF).
  • - A systematic review of 18 studies identified key factors such as social influences, environmental context, and beliefs about outcomes, which all contributed to variability in transfusion practices.
  • - Strategies to improve transfusion decision-making included provider audits, educational sessions, and enhancing communication among medical staff.
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The American College of Chest Physicians (CHEST) Antithrombotic Therapy for Venous Thromboembolism Disease evidence-based guidelines are now updated in a more frequent, focused manner. Guidance statements from the most recent full guidelines and two subsequent updates have not been gathered into a single source. An international panel of experts with experience in prior antithrombotic therapy guideline development reviewed the 2012 CHEST antithrombotic therapy guidelines and its two subsequent updates.

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Purpose: Simulation-based medical education (SBME) is provided by all anesthesiology residency programs in Canada. The purpose of this study was to characterize SBME in Canadian anesthesiology residency training programs.

Methods: We administered a 21-question survey to the simulation director/coordinator for all 17 Canadian academic departments of anesthesiology from October 2019 to January 2020.

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Article Synopsis
  • Ontario's 2013 introduction of a patient-based funding model (Quality-Based Procedures) for hip fracture care was studied to evaluate its impact on processes and outcomes.
  • The study analyzed health data before and after QBP implementation, focusing on factors like surgery timing, use of echocardiography, nerve blocks, and geriatric care, along with clinical outcomes like mortality and readmission rates.
  • Results showed an increase in nerve block usage but a decrease in echocardiography, with no significant change in clinical outcomes, highlighting the need for ongoing evaluation of the QBP program to guide future healthcare policies.
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Article Synopsis
  • - Vitiligo is an autoimmune skin disorder that causes loss of pigment, and new treatments like Janus Kinase inhibitors are showing promise for managing it.
  • - A case study involving a 61-year-old man with resistant vitiligo showed significant improvement after using oral Abrocitinib, a JAK inhibitor, for 2 months after prior treatments plateaued.
  • - More research, including ongoing clinical trials, is essential to evaluate the long-term effectiveness and safety of these oral Janus Kinase inhibitors for treating vitiligo.
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Prediction Models for Forecasting Risk of Development of Surgical Site Infection after Lower Limb Revascularization Surgery: A Systematic Review.

Ann Vasc Surg

May 2024

Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Electronic address:

Background: Surgical site infections (SSIs) are a common and potentially preventable complication of lower limb revascularization surgery associated with increased healthcare resource utilization and patient morbidity. We conducted a systematic review to evaluate multivariable prediction models designed to forecast risk of SSI development after these procedures.

Methods: After protocol registration (CRD42022331292), we searched MEDLINE, EMBASE, CENTRAL, and Evidence-Based Medicine Reviews (inception to April 4th, 2023) for studies describing multivariable prediction models designed to forecast risk of SSI in adults after lower limb revascularization surgery.

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