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Item Open Access Outcomes of intravitreal dexamethasone implant (Ozurdex®) in patients with post-surgical macular edema – a real-world scenario(2025-01-10) de Oliveira Júnior, Elder O.; Ahn, Isabel; Fernandes, Rodrigo A. B.; Fernandes, Arthur G.Abstract Background Clinically significant macular edema (CME) is the leading cause of visual loss after ophthalmologic surgery due to the release of inflammatory mediators promoted by the procedures. We aimed to evaluate the outcomes of intravitreal Ozurdex® (700 µg dexamethasone) implants as a primary therapeutical option for post-surgical macular edema cases. Methods Patients with post-surgical macular edema diagnosed by optical coherence tomography (Cirrus SD-OCT) and treated with Ozudex were selected for the current study. Data was retrospectively collected from medical records from January 2020 to December 2022 and included sex, age, laterality, and timeline of treatment (i.e. implant alone or at the time of silicon oil removal in cases requiring vitreorretinal surgery). Complications associated with treatment were also noted as well as the need of further treatments. The structural analysis focused on measuring central macular thickness (CMT—average thickness within the 1 mm circle of the ETDRS) from the internal limiting membrane to the Bruch’s membrane complex, as well as the average total macular thickness including parafoveal and perifoveal regions determined by the device (CAT). The functional evaluation was based on the best-corrected visual acuity (VA) measured in logMAR. Results A total of 46 participants were included (56.2% males, mean age: 60.9 ± 11.2 years old). A statistically significant change was observed in the postoperative versus the preoperative period for all parameters (p < 0.05). The mean VA difference was − 0.17 ± 0.24; CMT was − 109.22 ± 124.85 and CAT was − 14.76 ± 58.95. We observed a significant effect of the moment of Ozurdex implantation on VA improvement, so that cases with implantation at the time of oil removal showed lower improvement than cases with implantation at a distinct timing (Coef. 0.19, 95%CI: 0.02 to 0.36, p = 0.027). Eleven cases (23.9%) required further treatment such as new Ozurdex implantation (8 cases) or surgery (3 cases). Only one case (2.17%) showed increased intraocular pressure and underwent glaucoma surgery. Conclusions Intravitreal Ozurdex implants significantly improved functional and structural aspects in post-surgical macular edema. The timing of implantation influenced VA improvement, with a distinct step approach showing better outcomes than at the time of oil removal.Item Open Access Aggressive Subtypes of Laryngeal Chondrosarcoma and their Clinical Behavior: A Systematic Review(2025-01-05) Piazza, Cesare; Montenegro, Claudia; Tomasoni, Michele; Leivo, Ilmo; Stenman, Göran; Agaimy, Abbas; Simpson, Roderick H. W.; Zidar, Nina; Ferlito, AlfioAbstract Introduction Laryngeal chondrosarcoma (CS) is a rare indolent malignant tumor. High-grade (G3), dedifferentiated (DD), and myxoid (MY) CSs are considered more aggressive subtypes due to their metastatic potential and relatively poor outcomes. The aim of this systematic review is to evaluate treatment modalities and survival outcomes in patients affected by these rarer CS subtypes. Methods Papers published from January 1, 2000, to August 25, 2024, describing cases of laryngeal G3, DD, and MY CS were included. Results A total of 38 patients (15 G3, 13 DD, and 10 MY) were selected. Cricoid cartilage was the most common site of origin. Total laryngectomy (TL) was often performed. Primary conservative approaches in 42.8% of patients were followed by loco-regional recurrence. Conclusions Aggressive subtypes of CS require a radical approach because of the higher rate of loco-regional and distant recurrences compared to low-grade CS. TL with radical intent is the most common treatment, and adjuvant therapy should be considered after careful multidisciplinary discussion.Item Open Access Development and usability testing of a multifaceted intervention to reduce low-value injury care(2025-01-07) Bérubé, Mélanie; Lapierre, Alexandra; Sykes, Michael; Grimshaw, Jeremy; Turgeon, Alexis F.; Lauzier, François; Taljaard, Monica; Stelfox, Henry T.; Witteman, Holly; Berthelot, Simon; Mercier, Éric; Gonthier, Catherine; Paquet, Jérôme; Fowler, Robert; Yanchar, Natalie; Haas, Barbara; Lessard-Bonaventure, Paule; Archambault, Patrick; Gabbe, Belinda; Guertin, Jason R.; Ouyang, Yougdong; Moore, LynneAbstract Background Multifaceted interventions that address barriers and facilitators have been shown to be most effective for increasing the adoption of high-value care, but there is a knowledge gap on this type of intervention for the de-implementation of low-value care. Trauma is a high-risk setting for low-value care, such as unnecessary diagnostic imaging and the use of specialized resources. The aim of our study was to develop and assess the usability of a multifaceted intervention to reduce low-value injury care. Methods We used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change tool as theoretical foundations to identify barriers and facilitators, and strategies for the reduction of low-value practices. We designed an initial prototype of the intervention using the items of the Template for Intervention Description and Replication. The prototype’s usability was iteratively tested through four focus groups and four think-aloud sessions with trauma decision-makers (n = 18) from seven Level I to Level III trauma centers. We conducted an inductive analysis of the audio-recorded sessions to identify usability issues and other barriers and facilitators to refine the intervention. Results We identified barriers and facilitators related to individual characteristics, including knowledge and beliefs about low-value practices and the de-implementation process, such as the complexity of changing practices and difficulty accessing performance feedback. Accordingly, the following intervention strategies were selected: involving governing structures and leaders, distributing audit & feedback reports on performance, and providing educational materials, de-implementation support tools and educational/facilitation visits. A total of 61 issues were identified during the usability testing, of which eight were critical, 33 were moderately important, and 18 were minor. These issues led to numerous improvements, including the addition of information on the drivers and benefits of reducing low-value practices, changes in the definition of these practices, the addition of proposed strategies to facilitate de-implementation, and the tailoring of educational/facilitation visits. Conclusions We designed and refined a multifaceted intervention to reduce low-value injury care using a process that increases the likelihood of its acceptability and sustainability. The next step will be to evaluate the effectiveness of implementing this intervention using a pragmatic cluster randomized controlled trial. Trial registration This protocol has been registered on ClinicalTrials.gov (February 24th 2023, #NCT05744154, https://clinicaltrials.gov/ct2/show/NCT05744154 ).Item Open Access Examining factorial validity and internal consistency of Professional Quality of Life (ProQoL-9) among care aides working in Long-term Care (LTC)(2025-01-02) Saeidzadeh, Seyedehtanaz; Wang, Anni; Duan, Yinfei; Hipel, Isaiah; Norton, Peter G.; Estabrooks, Carole A.Abstract Background The ProQoL (30 items) is a widely used instrument of work-related quality of life for health care workers. Recently, a shorter 9-item version of the ProQoL was developed and validated among palliative care workers. The ProQoL-9 consists of three subscales: compassion satisfaction (CS), burnout (BO), and compassion fatigue (CF). Care aides (personal support workers, nursing assistants) are an understudied population in terms of their professional quality of life. It is critical to use validated instruments to measure their experiences. The purpose of this study was to examine the internal consistency and factorial structure of the ProQoL-9 among care aides working in LTC. Methods We used surveys collected by the Translating Research in Elder Care (TREC), a pan-Canadian program that collects longitudinal surveys from the healthcare workforce in the LTC. We used TREC surveys containing information on demographics, characteristics of LTC homes (e.g., ownership model), and the ProQoL-9. Our sample included all care aides who completed TREC surveys in the province of Alberta, Canada, from 2020–2021. We examined internal consistency via alpha and omega coefficients. To examine the factorial structure, we conducted confirmatory factor analysis (CFA) testing one factor, two factors (CF and BO together & CS), and three factor models (CF, BO, and CS). Results N = 760 care aides completed the surveys in Alberta. The majority were female (90.79%) and worked in general LTC units (55.29%). The Cronbach’s alpha results showed an overall α = 0.56 for the whole scale and adequate reliability of the subscales (α = 0.73 for CS, α = 0.68 for CF, and α = 0.75 for BO). The omega reliability results for all the subscales were ≥ 0.70, reflecting good internal consistency (BO = 0.77, CS = 0.73, and CF = 0.70). The three-factor model had the best goodness of fit values, reflecting an adequate goodness of fit (X2 = 165.82, DF = 24, X2/DF = 6.9, P < .0001, RMSEA = 0.08, CFI = 0.92, TLI = 0.89). Conclusions The ProQoL-9 is a valid and reliable instrument among care aides in LTC. The factorial structure shows that this shorter version of the ProQoL is rigorously designed and can be utilized by health service researchers in LTC.Item Open Access Approaches and outcomes of adalimumab discontinuation in patients with well-controlled inflammatory arthritis: a systematic search and review(2024-12-30) Balay-Dustrude, Erin; Fennell, Jessica; Baszis, Kevin; Goh, Y. I.; Horton, Daniel B.; Lee, Tzielan; Rotman, Chloe; Sutton, Anna; Twilt, Marinka; Halyabar, OlhaAbstract Objective This systematic search and review aimed to evaluate the available literature on discontinuation of adalimumab and other tumor necrosis factor inhibitors (TNFi) for patients with well-controlled chronic inflammatory arthritides. Methods We conducted a publication search on adalimumab discontinuation from 2000–2023 using PubMed, CINAHL, EMBASE, and Cochrane Library. Included studies evaluated adalimumab discontinuation approaches, tapering schemes, and outcomes including successful discontinuation and recapture after flare, in patients with well-controlled disease. Studies included evaluated rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and juvenile idiopathic arthritis (JIA). Results Forty-nine studies were included. Studies evaluating adalimumab alone were limited, and many reported TNFi outcomes as a single entity. Studies on rheumatoid arthritis (RA) (32, 8 RCTs) reported flare rates from 33–87%. Flares with medication tapering were slightly lower than with abrupt stop, and successful recapture was generally high (80–100%). Studies on spondyloarthropathy (12, 4 RCTs), focused on tapering, noting lower flare rates in tapering rather than abruptly stopping, and high recapture rates (~ 90%). Studies on JIA (5) were observational and demonstrated modestly lower flare rates with tapering (17–63%) versus abrupt stopping (28–82%). There was notable variability in study design, follow-up duration, specificity for TNFi results, and controlled pediatric studies. Conclusion The literature evaluating adalimumab and other TNFi discontinuation, flare rates, and recapture success within the inflammatory arthritis population demonstrated less flare when medications were tapered, over abrupt stop in the RA, spondyloarthropathy, and JIA populations. When medications were restarted after flare, recapture of well-controlled disease was generally high in RA and spondyloarthropathy, and generally favorable in JIA.Item Open Access Identification of progressive pulmonary fibrosis: consensus findings from a modified Delphi study(2024-12-31) Wells, Athol U.; Walsh, Simon L. F.; Adegunsoye, Ayodeji; Cottin, Vincent; Danoff, Sonye K.; Devaraj, Anand; Flaherty, Kevin R.; George, Peter M.; Johannson, Kerri A.; Kolb, Martin; Kondoh, Yasuhiro; Nicholson, Andrew G.; Tomassetti, Sara; Volkmann, Elizabeth R.; Brown, Kevin K.Abstract Background We sought consensus among practising respiratory physicians on the prediction, identification and monitoring of progression in patients with fibrosing interstitial lung disease (ILD) using a modified Delphi process. Methods Following a literature review, statements on the prediction, identification and monitoring of progression of ILD were developed by a panel of physicians with specialist expertise. Practising respiratory physicians were sent a survey asking them to indicate their level of agreement with these statements on a binary scale or 7-point Likert scale (− 3 to 3), or to select answers from a list. Consensus was considered to be achieved if ≥ 70% of respondents selected the same answer, or, for responses on a Likert scale, the median score was ≤ –2 (disagree/not important) or ≥ 2 (agree/important) with an interquartile range ≤ 1. There were three rounds of the survey. Results Surveys 1, 2 and 3 were completed by 207, 131 and 94 physicians, respectively, between March 2022 and July 2023. Decline in forced vital capacity (FVC), decline in diffusing capacity of the lungs for carbon monoxide, and increased fibrosis on high-resolution computed tomography (HRCT) were ranked as the most important endpoints for determining progression. Consensus was reached that progression on HRCT or a decline in FVC ≥ 10% from baseline is sufficient to determine progression, and that small declines in multiple endpoints indicates progression. Consensus was reached that a histological pattern of usual interstitial pneumonia (UIP) is a risk factor for progression of ILD, but that a biopsy to look for a UIP pattern should not be performed solely for prognostic reasons. Consensus was not reached on the time period over which progression should be defined. There was consensus that appropriate management of ILD depends on the type of ILD, and that ‘despite adequate management’ or ‘despite usual management’ should be included in the definition of progression. Conclusions This modified Delphi process provided consensus statements on the identification of ILD progression that were supported by a broad group of clinicians and may help to inform clinical practice until robust evidence-based guidelines are available.Item Open Access Therapeutic reduction of neurocan in murine intracerebral hemorrhage lesions promotes oligodendrogenesis and functional recovery(2025-01-04) Li, Hongmin; Ghorbani, Samira; Oladosu, Olayinka; Zhang, Ping; Visser, Frank; Dunn, Jeff; Zhang, Yunyan; Ling, Chang-Chun; Yong, V. W.; Xue, MengzhouAbstract Background Intracerebral hemorrhage (ICH) causes prominent deposition of extracellular matrix molecules, particularly the chondroitin sulphate proteoglycan (CSPG) member neurocan. In tissue culture, neurocan impedes the properties of oligodendrocytes. Whether therapeutic reduction of neurocan promotes oligodendrogenesis and functional recovery in ICH is unknown. Methods Mice were retro-orbitally injected with adeno-associated virus (AAV-CRISPR/Cas9) to reduce neurocan deposition after ICH induction by collagenase. Other groups of ICH mice were treated with vehicle or a drug that reduces CSPG synthesis, 4-4-difluoro-N-acetylglucosamine (difluorosamine). Rota-rod and grip strength behavioral tests were conducted over 7 or 14 days. Brain tissues were investigated for expression of neurocan by immunofluorescence microscopy and western blot analysis. Brain cryosections were also stained for microglia/macrophage phenotype, oligodendrocyte lineage cells and neuroblasts by immunofluorescence microscopy. Tissue structural changes were assessed using brain magnetic resonance imaging (MRI). Results The adeno-associated virus (AAV)-reduction of neurocan increased oligodendrocyte numbers and functional recovery in ICH. The small molecule inhibitor of CSPG synthesis, difluorosamine, lowered neurocan levels in lesions and elevated numbers of oligodendrocyte precursor cells, mature oligodendrocytes, and SOX2+ nestin+ neuroblasts in the perihematomal area. Difluorosamine shifted the degeneration-associated functional state of microglia/macrophages in ICH towards a regulatory phenotype. MRI analyses showed better fiber tract integrity in the penumbra of difluorosamine mice. These beneficial difluorosamine results were achieved with delayed (2 or 3 days) treatment after ICH. Conclusion Reducing neurocan deposition following ICH injury is a therapeutic approach to promote histological and behavioral recovery from the devastating stroke.Item Open Access Built environment change for injury prevention: insights from public health professionals across public health units in Ontario, Canada(2025-01-03) McCullogh, Emily; Macpherson, Alison; Harrington, Daniel W.; Pike, Ian; Hagel, Brent; Buchan, Claire; Fuselli, Pamela; Richmond, Sarah A.Abstract Background Road-related injuries and deaths are among the most significant and avoidable public health problems in Canada. Modifications to the built environment (BE) can reduce injury rates for vulnerable road users (VRUs) and other priority populations who experience disproportionate risk. This paper highlights public health professionals’ experiences working in injury prevention across Ontario public health units (PHUs) navigating barriers and facilitators to BE change. Their perspectives offer valuable insights that can support future BE change work in the Ontario public health context, thus illustrating the importance of including practitioners’ voices in injury prevention research. Methods Qualitative data were collected for a larger pan-Canadian study examining barriers and facilitators to BE change from the perspectives of injury prevention and transport professionals working across a variety of sectors, including public health, using key informant interviews (KI) and virtual focus groups (VFGs). Participants (n = 9) from four PHUs are included in this present study: Peel Region; York Region; Peterborough; and Ottawa. Thematic analysis was used to organize and code the data in relation to the guiding principles of the Ontario Public Health Standards (OPHS), situating our results within the broader context of public health and road-related injury prevention in Ontario. Results Major barriers included motor vehicle prioritization and decision-making structures. Facilitators included partnerships and collaboration, champions and advocates, and access to data. Lastly, participants highlighted the important role of public health in BE change discussions and decision-making for road-related injury prevention. Conclusion Public health professionals’ insights about barriers and facilitators show that some of their work aligns with the existing OPHS. Needs of local populations are clearly identified, while local data illustrating the impact of public health interventions are lacking. There are limits to PHU’s capacities, as well as the capacities of communities, which can be strengthened through the work of champions and advocates. Partnerships, collaboration, and engagement are also significant facilitators to BE change, aligning with the OPHS, but PHUs need to be involved more in BE change processes in order to prioritize the safety needs of VRUs in local communities.Item Open Access Ca2+ signaling in vascular smooth muscle and endothelial cells in blood vessel remodeling: a review(2024-12-27) Suzuki, Yoshiaki; Giles, Wayne R.; Zamponi, Gerald W.; Kondo, Rubii; Imaizumi, Yuji; Yamamura, HisaoAbstract Vascular smooth muscle cells (VSMCs) and endothelial cells (ECs) act together to regulate blood pressure and systemic blood flow by appropriately adjusting blood vessel diameter in response to biochemical or biomechanical stimuli. Ion channels that are expressed in these cells regulate membrane potential and cytosolic Ca2+ concentration ([Ca2+]cyt) in response to such stimuli. The subsets of these ion channels involved in Ca2+ signaling often form molecular complexes with intracellular molecules via scaffolding proteins. This allows Ca2+ signaling to be tightly controlled in localized areas within the cell, resulting in a balanced vascular tone. When hypertensive stimuli are applied to blood vessels for extended periods, gene expression in these vascular cells can change dramatically. For example, alteration in ion channel expression often induces electrical remodeling that produces a depolarization of the membrane potential and elevated [Ca2+]cyt. Coupled with endothelial dysfunction blood vessels undergo functional remodeling characterized by enhanced vasoconstriction. In addition, pathological challenges to vascular cells can induce inflammatory gene products that may promote leukocyte infiltration, in part through Ca2+-dependent pathways. Macrophages accumulating in the vascular adventitia promote fibrosis through extracellular matrix turnover, and cause structural remodeling of blood vessels. This functional and structural remodeling often leads to chronic hypertension affecting not only blood vessels, but also multiple organs including the brain, kidneys, and heart, thus increasing the risk of severe cardiovascular events. In this review, we outline recent advances in multidisciplinary research concerning Ca2+ signaling in VSMCs and ECs, with an emphasis on the mechanisms underlying functional and structural vascular remodeling.Item Open Access Towards a histological diagnosis of childhood small vessel CNS vasculitis(2024-12-28) Nouri, Maryam N.; Dropol, Anastasia; Tyrrell, Pascal N.; Sheikh, Sheila; Twilt, Marinka; Michaud, Jean; Ellezam, Benjamin; Sarnat, Harvey B.; Dunham, Christopher; Schutz, Peter W.; Keith, Julia; Munoz, David G.; Vinters, Harry V.; Hawkins, Cynthia; Benseler, Susanne M.Abstract 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. Methods A standardized brain biopsy scoring instrument was developed and applied to consecutive full-thickness brain biopsies of pediatric cases and controls at a single center. Stains included immunohistochemistry and Hematoxylin & Eosin. Nine North American neuropathologists, blinded to patients’ presentation, diagnosis, and therapy, scored de-identified biopsies independently. Results A total of 31 brain biopsy specimens from children with sv-cPACNS, 11 with epilepsy, and 11 with non-vasculitic inflammatory brain disease controls were included. Angiocentric inflammation in the cortex or white matter increases the likelihood of sv-cPACNS, with odds ratios (ORs) of 3.231 (95CI: 0.914–11.420, p = 0.067) and 3.923 (95CI: 1.13–13.6, p = 0.031). Moderate to severe inflammation in these regions is associated with a higher probability of sv-cPACNS, with ORs of 5.56 (95CI: 1.02–29.47, p = 0.046) in the cortex and 6.76 (95CI: 1.26–36.11, p = 0.025) in white matter. CD3, CD4, CD8, and CD20 cells predominated the inflammatory infiltrate. Reactive endothelium was strongly associated with sv-cPACNS, with an OR of 8.93 (p = 0.001). Features reported in adult sv-PACNS, including granulomas, necrosis, or fibrin deposits, were absent in all biopsies. The presence of leptomeningeal inflammation in isolation was non-diagnostic. Conclusion Distinct histological features were identified in sv-cPACNS biopsies, including moderate to severe angiocentric inflammatory infiltrates in the cortex or white matter, consisting of CD3, CD4, CD8, and CD20 cells, alongside reactive endothelium with specificity of 95%. In the first study of its kind proposing histological criteria for evaluating brain biopsies, we aim to precisely characterize the type and severity of the inflammatory response in patients with sv-cPACNS; this can enable consolidation of this population to assess outcomes and treatment methodologies comprehensively.Item Open Access Assessing the impact of the iPeer2Peer program for adolescents with juvenile idiopathic arthritis: a mixed-methods randomized controlled trial(2024-12-27) Nishat, Fareha; Kelenc, Lauren; Berard, Roberta; Duffy, Ciaran; Feldman, Brian; Forgeron, Paula; Huber, Adam M.; Luca, Nadia; Schmeling, Heinrike; Spiegel, Lynn; Tucker, Lori; Watanabe-Duffy, Karen; Killackey, Tieghan; Lalloo, Chitra; Wiles, Brittany; Nair, Anya; Olaizola, Sofia; McDermott, Brenna; Tavangar, Farideh; Kohut, Sara A.; Stinson, Jennifer N.Abstract Background Juvenile Idiopathic Arthritis (JIA) is a chronic pediatric illness, whereby youth experience physical, emotional and psychosocial challenges that result in reduced health related quality of life (HRQL). Peer mentoring has been shown to improve disease self-management in adults with chronic conditions, with mixed results in younger populations. Building on our pilot work – which supported the feasibility and initial effectiveness of the iPeer2Peer program – the objective of this study was to assess the clinical effectiveness of the program in youth with JIA through a waitlist randomized controlled trial. Methods Eighty-one youth (aged 12–18) were randomized to the intervention group and matched with trained peer mentors (18–25 years; successfully managing their JIA), completing of up to ten 30-min video calls over a 15-week period. Eighty-three youth in the control group received standard care. Outcome assessments occurred at enrollment, 15 weeks post randomization and 6-months post randomization. The primary outcome was self-management, measured using the TRANSITION-Q. Secondary outcomes were HRQL, pain, emotional distress, disease knowledge, self-efficacy, and perceived social support. These were assessed using linear mixed effects models. Content analysis of semi-structured interviews and focus groups was used to assess satisfaction with the program with mentors and mentees upon study completion. Results In total, 164 youth (mean age 14.4 ± 1.9 years, 78% female) were randomized to the study. The proposed sample size was not reached due to challenges in recruitment, likely impacted by the COVID-19 pandemic. The iPeer2Peer program did not show significant improvement in self-management (p = 0.7), or any of the secondary outcomes. Three key categories emerged from content analysis: (1) Fulfillment and Support Through Shared Experience, (2) Enhancing Program Delivery and (3) Strategies to Boost Engagement. These findings highlight that mentees valued the ability to converse with mentors who empathized with their disease experience, while mentors found it fulfilling to support mentees, and noted that they could have benefited from this type of support themselves. Conclusion While the iPeer2Peer did not result insignificant changes in clinical outcomes, both mentors and mentees were satisfied with the program and felt that mentorship provided real-world benefits for disease management and overall wellbeing. Trial registration ClinicalTrials.gov, NCT03116763. Registered 31, March 2017, https://www.clinicaltrials.gov/study/NCT03116763Item Open Access Extending the Calgary Audit and Feedback Framework into the virtual environment: a process evaluation and empiric evidence(2024-12-18) Woodhouse, Douglas; Duncan, Diane; Ferrie, Leah; Omodon, Onyebuchi; Mehta, Ashi; Pokharel, Surakshya; Ambasta, AnshulaAbstract Background The Calgary Audit and Feedback Framework (CAFF) is a pragmatic, evidence-based approach for the design and implementation of in-person social learning interventions using Audit and Group Feedback (AGF). This report describes extension of CAFF into the virtual environment as part of a multifaceted intervention bundle to reduce redundant daily laboratory testing in hospitals. We evaluate the process of extending CAFF in the virtual environment and share resulting evidence of participant engagement with planning for practice change. Methods We describe an innovative virtually facilitated AGF intervention based on the CAFF. The AGF intervention was part of an intervention bundle which included individual physician laboratory test utilization reports and educational tools to reduce redundant daily laboratory testing in hospitals. We used data from recorded and transcribed virtual AGF sessions, post AGF session surveys and detailed field notes maintained by project team members. We used simple descriptive statistics for quantitative data and analyzed qualitative data according to the elements of CAFF. Results Eighty-three physicians participated over twelve virtual AGF sessions conducted across four tertiary care hospitals during the study period. We demonstrate that all prerequisite activities for CAFF (relationship building, question choice and data representation) were present in every virtual AGF session. Virtual facilitation was effective in supporting the transition of participants through different steps of CAFF in each session to lead to change talk and planning. All participants contributed to discussion during the AGF sessions. The post AGF session surveys were filled by 66% of participants (55/83), with over 90% of respondents reporting that the session helped them improve practice. 46% of participants (38/83) completed personal commitment to change forms at the end of the sessions. Conclusions Virtual AGF sessions, developed and implemented with fidelity to the CAFF approach, successfully engaged physicians in a group learning environment that led to change planning. Further studies are needed to determine the generalizability of our findings and to add to the literature on evidence-based virtual facilitation techniques.Item Open Access PEARLS debriefing for social justice and equity: integrating health advocacy in simulation-based education(2024-12-18) Soilis, Niki; Kinsella, Elizabeth A.; Eppich, Walter; Cheng, Adam; Beavers, Lindsay; Bhanji, FarhanAbstract Addressing health inequities in health professions education is essential for preparing healthcare workers to meet the demands of diverse communities. While simulation has become a widely recognized and effective method for providing safe and authentic clinical learning experiences, there has been limited attention towards the power of simulation in preparing health practitioners to work with groups who experience health disparities due to systems of inequality. Balancing technical proficiency with educational approaches that foster critical reflection and inform action oriented towards social accountability is essential. Transformational learning promotes the development of critical consciousness through critical reflection. Debriefing plays a crucial role in fostering learning in this direction by providing a structured opportunity to critically reflect on taken for granted assumptions, examine power and privilege embedded within systems and structures, and empower learners to take action toward changing those conditions. Building on the Promoting Excellence and Reflective Learning in Simulation (PEARLS) Healthcare Debriefing Tool, we propose a PEARLS Debriefing for Social Justice and Equity (DSJE) Tool that specifically directs attention to systems of inequality that contribute to health disparities for vulnerable groups across a range of simulation scenarios. This approach has two aims: (a) to transform debriefings into a critically reflective space by engaging learners in dialogue about social and structural determinants of health that may create or perpetuate inequities and (b) to foster critical reflection on what actions can be taken to improve the health and well-being of identified at risk and vulnerable groups. From this perspective, we can use the adapted PEARLS Tool to incorporate conversations about systems of inequality, equity, diversity, and inclusion (EDI) into our existing educational practices, and make concentrated efforts towards community-driven and socially conscious simulation-based education (SBE).Item Open Access When common cognitive biases impact debriefing conversations(2024-12-18) Meguerdichian, Michael J.; Trottier, Dana G.; Campbell-Taylor, Kimberly; Bentley, Suzanne; Bryant, Kellie; Kolbe, Michaela; Grant, Vincent; Cheng, AdamAbstract Healthcare debriefing is a cognitively demanding conversation after a simulation or clinical experience that promotes reflection, underpinned by psychological safety and attention to learner needs. The process of debriefing requires mental processing that engages both “fast” or unconscious thinking and “slow” intentional thinking to be able to navigate the conversation. “Fast” thinking has the potential to surface cognitive biases that impact reflection and may negatively influence debriefer behaviors, debriefing strategies, and debriefing foundations. As a result, negative cognitive biases risk undermining learning outcomes from debriefing conversations. As the use of healthcare simulation is expanding, the need for faculty development specific to the roles bias plays is imperative. In this article, we hope to build awareness about common cognitive biases that may present in debriefing conversations so debriefers have the chance to begin the hard work of identifying and attending to their potential detrimental impacts.Item Open Access From ‘publish or perish’ to ‘publish with purpose’: perspectives from young adults with lived and living experience on transforming academic publishing in patient-oriented research(2024-12-20) Rao, Sandy; Jardine, Rae; Suthakaran, Abitha; Satam, Laetitia; Todorova, Antoaneta A.; Tumaneng, Ysabelle; Quickstad, JulienAbstract Background This commentary article critically assesses the inclusion and recognition of young adults with lived and living experiences (YALLE) in academic publishing. Stemming from our involvement in a health research study, this analysis interrogates the disparity between the stated importance of YALLE contributions in health research and their actual recognition, specifically in academic publications, which serve as the principal “currency” in research. This tokenism limits the potential for their unique insights to substantially enrich the discourse and dissemination of knowledge. Set against a backdrop of systemic biases and structural barriers, this discussion underscores the persistent minoritization of YALLE, despite increasing nominal recognition within academic and health research communities. Main text The commentary begins by placing the engagement of young adults in health research within its current context, showing that this inclusion often remains superficial, serving more as a symbolic gesture toward inclusivity rather than fostering genuine participatory research. It critiques the implicit biases within institutional frameworks that continue to shape research culture detrimentally, thus stifling the transformative potential of research led and partnered by young adults. The core of the narrative addresses the complex challenges faced by YALLE, including discrimination, underrecognition, and inadequate participatory roles in research processes. These issues are magnified by the prevalent “publish or perish” culture in academia, which prioritizes the quantity of scholarly output over the quality and inclusivity of research contributions. Conclusions The commentary advocates for a crucial shift in academic publishing to genuinely appreciate and integrate the contributions of young adults. We call for a transition from a “publish or perish” model to a “publish with purpose” approach, which necessitates rethinking what is considered valuable knowledge and who is acknowledged as its creators. This shift aims to cultivate an academic culture where knowledge is treated as a communal resource, and publications are used as tools to advance societal understanding and progress.Item Open Access Establishing patient partners’ roles on research teams: a scoping review(2024-12-18) Tobiano, Georgia; Gillespie, Brigid M.; Carlini, Joan; Muir, Rachel; Rasiah, Jananee; Wan, Ching S.; McCarron, Tamara L.; Moffat, Karen; Jahandideh, Sepideh; Chaboyer, WendyAbstract Background There are a myriad of ways patient partners can enact their roles on research teams. International guidelines emphasize the need for a collaborative approach to determining these roles to try to improve research impact and positive patient partner experience. The aims of this review were to: (1) describe how patient partners’ roles as co-researchers in health research are determined; and (2) identify factors that influence how these decisions are made. Methods A scoping review was conducted. Four databases were searched plus citation searching occurred. Descriptions of English language studies of any design and commentaries of studies that report on patient partners’ or researchers’ reflections on their decision-making processes for engagement were included. Two reviewers completed screening and data extraction, with a third to resolve disagreements. Results were summarized and then content analysis was undertaken to synthesize the findings. Two patient partners contributed to the protocol development, screening, data interpretation, and manuscript writing at varying times during the process. Results A total of 45 papers (25 commentaries, 19 studies and 1 both a study and commentary) were included in this review. Most papers were from the United Kingdom (n = 15) and Canada (n = 12). Most patient partners had experiences related to chronic conditions rather than acute or time-limited illnesses. The synthesis yielded two categories. The first category, the research and research team attributes shape patient partner roles, encompassed patient partner, researcher and activity related factors that influenced patient partner engagement in activities. The second category, shared and ongoing decision-making, described the decision-making process to determine patient partner engagement, timing of these decisions, and tools to support these decisions. Conclusion A dynamic, systematic and shared decision-making approach to determining patient partners’ roles in the research process has the potential to support meaningful engagement and maximize benefits. Because the research process may evolve over time and patient partners situations can change, there may be a need to renegotiate the patient partner’s role.Item Open Access Rates of post procedural prophylactic antibiotic use following cardiac implantable electronic device insertion and the impact on surgical site infections in Alberta, Canada(2024-12-18) Rennert-May, Elissa; Leal, Jenine; Zhang, Zuying; Rajakumar, Irina; Smith, Stephanie; Conly, John M.; Exner, Derek; Kuriachan, Vikas; Chew, DerekAbstract Background The necessity of post procedural prophylactic antibiotics following clean surgeries is controversial. While most evidence suggests that there is no benefit from these additional antibiotics and guidelines do not support their use, there is a paucity of evidence as to how often they are still being used and their impact on infection outcomes. The current study assessed the use of prophylactic antibiotics following cardiac implantable electronic device (CIED) implantations in the province of Alberta, and their impact on infection and mortality. Methods We conducted a population-based cohort study in the province of Alberta. Administrative data was used to link all patients ≥ 18 who underwent outpatient CIED implantation from January 1, 2011 through December 31, 2019 to antibiotics commonly used for surgical prophylaxis which were prescribed within 48 h of implantation. The primary outcome, explored with an adjusted Poisson model, was incidence of complex surgical site infection within one year of device implantation. All-cause mortality was a secondary outcome. Results Post implantation prophylactic antibiotics were used 41% of the time overall, though the rate has been decreasing over time. The most commonly used prophylactic antibiotic was cefalexin (52%). When adjusted analyses were completed, there was no difference in the outcome of infection between those who did and did not receive post implantation prophylactic antibiotics (Relative Risk 0.74, 95% CI 0.46–1.17) and there was no difference in mortality (Relative Risk 0.8, 95% CI 0.63–1.02). Conclusions The use of prophylactic antibiotics following CIED implantation does not correlate to a reduced rate of complex surgical site infection or reduced mortality. The widespread use of these antibiotics, which is not guideline concordant, suggests the need for targeted antimicrobial stewardship interventions for surgical prophylaxis to ensure that antibiotic use is being optimized. Further work should explore other adverse outcomes associated with this antibiotic usage and stewardship programs should explore interventions to educate and reduce antibiotic use for this indication.Item Open Access Applying an ICD-10 to ICD-11 mapping tool to identify causes of death codes in an Alberta dataset(2024-12-18) Doktorchik, Chelsea; Southern, Danielle A.; King, James A.; Quan, HudeAbstract Background The most recent and 11th revision of the International Classification of Disease (ICD-11) is in use as of January 2022, and countries around the globe are now preparing for the implementation of ICD-11 and transition from the 10th revision (ICD-10). Translation of current coding is required for historical comparisons. Methods We applied the World Health Organization (WHO) mapping tables to current Centers for Disease Control and Prevention (CDC) Lists of ICD-10 coding of underlying causes of death to assess what ICD-11 codes look like in an Alberta sample of causes of death (COD). We prepared frequency tables for a single year of COD in Alberta based on the CDC grouping of COD. Results The mapping success rate at the ICD-10 code level for the adult population (> 18 years) was 96.6% and 100% for children (1–17 years) and infants (< 1 year). The mapping success rate by patient was 99.5% for the adult population patient deaths and 100% for children and infants. We mapped ICD-11 codes to identify the ten most frequently reported underlying COD in Alberta for 24,645 deaths in adults, children, and infants in 2017. Conclusions Apart from two codes, all ICD-10 codes could be mapped to ICD-11 for underlying COD. These findings suggest that the ability to translate from the two iterations of coding will be feasible for future applications of health services data.Item Open Access Outcomes of patients receiving urgent palliative radiotherapy for advanced lung cancer: an observational study(2024-12-21) Xu, Yang; Trach, Celestee; Tessier, Tracey; Sinha, Rishi; Skarsgard, DavidAbstract Background There is considerable variability in the management of patients with advanced lung cancer referred for palliative radiotherapy owing to uncertainties in prognosis and the benefit of treatment. This study presents the outcomes of patients seen in the Fast Track Lung Clinic, an urgent access palliative radiotherapy clinic, and aims to identify factors associated with treatment response and survival. Methods Consecutive patients with advanced lung cancer seen in the Fast Track Lung Clinic between January 2014 and July 2020 were included. Patients who underwent radiotherapy were contacted beginning 30 days after radiotherapy to evaluate treatment response. Cluster bootstraps were used to compute confidence intervals for treatment response rate. Prognostic factors for treatment response and overall survival were identified using multivariable generalized estimating equations and Cox regression models, respectively. Results A total of 558 patients were included, of whom 459 (82.3%) consented to palliative radiotherapy for 1053 indications. The overall treatment response rate was 70.0% (95% CI, 65.8-74.2) for indications with follow-up (70.8%). Higher response rates were observed in patients with better ECOG performance status (OR per point, 0.71; 95% CI, 0.55-0.93; P = 0.01 ) and EGFR-mutant non-small cell lung cancer (OR vs wild-type, 2.46; 95% CI, 1.35-4.51; P = 0.003 ), whereas patients treated for neurological symptoms had lower response rates (OR, 0.27; 95% CI, 0.16-0.45; P < 0.001 ). There was no difference in response rate between patients who died within 30 days of starting radiotherapy and those who survived longer (OR, 0.83; 95% CI, 0.42-1.67; P = 0.61 ). Age; ECOG performance status; smoking history; pathology; EGFR or ALK mutation status; and the presence of liver, adrenal, or brain metastases were associated with overall survival. Conclusions Palliative radiotherapy was effective for patients with advanced lung cancer, although response rates varied by patient characteristics and treatment indication. This study identified prognostic factors for radiotherapy response and overall survival that can inform treatment decisions in this population.Item Open Access CaV3.2 T-type calcium channels contribute to CGRP- induced allodynia in a rodent model of experimental migraine(2024-12-18) Baggio, Darciane F.; Gambeta, Eder; Souza, Ivana A.; Huang, Sun; Zamponi, Gerald W.; Chichorro, Juliana G.Abstract Background Migraine is a painful neurological syndrome characterized by attacks of throbbing headache, of moderate to severe intensity, which is associated with photo- and phono- sensitivity as well as nausea and vomiting. It affects about 15% of the world’s population being 2–3 times more prevalent in females. The calcitonin gene-related peptide (CGRP) is a key mediator in the pathophysiology of migraine, and a significant advance in the field has been the development of anti-CGRP therapies. The trigeminal ganglion (TG) is thought to be an important site of action for these drugs. Moreover, experimental migraine can be induced by CGRP injection in the TG. The signaling pathway induced by CGRP in the TG is not fully understood, but studies suggest that voltage-gated calcium channels contribute to CGRP effects relevant to migraine. Objective We hypothesised that CGRP injection in the TG enhances CaV3.2 T-type calcium channel currents to contribute to the development of periorbital mechanical allodynia. Results A Co-Immunoprecipitation assay in tsA-201 cells revealed that CaV3.2 channels form a complex with RAMP-1, a component of the CGRP receptor. Constitutive CGRPR activity was able to inhibit CaV3.2 channels and induce a depolarizing shift in both activation and inactivation curves. Incubation of TG neurons with CGRP increased T-type current density by ~ 3.6 fold, an effect that was not observed in TG neurons from CaV3.2 knockout mice. Incubation of TG neurons with Z944, a pan T-type channel blocker, resulted in an approximately 80% inhibition of T-type currents. In vivo, this treatment abolished the development of periorbital mechanical allodynia induced by CGRP in male and female mice. Likewise, CaV3.2 knockout mice did not develop periorbital mechanical allodynia after intraganglionic CGRP injection. Finally, we demonstrated that the CGRP effect depends on the activation of its canonical GPCR, followed by protein kinase A activation. Conclusion The present study suggests that CGRP modulates CaV3.2 in the TG, an effect possibly mediated by the canonical CGRP receptor and PKA activation. The increase in T-type currents in the TG may represent a contributing factor for the initiation and maintenance of the headache pain during migraine. Graphical abstract