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Wound care remains a high-priority area for improvement in the Canadian health care system. Older adults aged 65 and older are disproportionately affected by chronic and non-healing wounds and often experience multiple co-morbid conditions, challenges which can be further complicated by living in rural and northern areas. A workshop-based multi-methods study was conducted to describe rural and northern perspectives on opportunities and feasibility to implement innovative wound care technologies. Each workshop included pre- and post- workshop surveys, a live demonstration of Swift Skin and Wound, a Q&A session, and facilitated discussion exploring the technology's feasibility, usability, and accessibility in northern and rural care contexts. Participants who volunteered for the study included care staff and healthcare executives (N = 11), described their perspectives on implementing AI-driven digital wound care management solutions with a focus on integration into health care settings. Three themes were identified including: confidence and optimism in improving wound care management, recognition of the superiority of AI-driven digital wound care solutions over current practices, and the importance of adaptable change processes for successful adoption. While generalizability may be limited, findings suggest that adopting AI-driven wound care tools could improve wound assessment accuracy and streamline care for aging populations in rural and northern areas.
Poor chest health is the leading cause of early mortality in children with cerebral palsy (CP). It is also the most common reason to seek healthcare, accruing significant costs and reducing quality-of-life for children and families. Clinical trials examining chest health interventions in CP are characterised by inconsistent outcome measures, limiting the capacity for evidence synthesis to inform clinical application. The study aims to develop a core outcome set (COS) and related measurement instruments to assess, monitor and evaluate chest health in children with CP, both in research and routine clinical practice. The COS will reflect the views of children, young people, parent/carers, clinicians and researchers, emphasising under-represented groups in research and those at risk of poorer chest health.
A 3-phase methodology will be conducted in line with the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. (1) Candidate outcomes will be identified through a qualitative evidence synthesis and interviews with key stakeholders. Findings will be mapped to COMET-taxonomy, generating a list of candidate outcomes. (2) An international e-Delphi survey will invite stakeholders to rate the importance of each outcome, followed by a consensus meeting to ratify the COS. (3) A structured review, guided by health measurement taxonomy, will evaluate relevant instruments, with a final meeting to agree on recommended measures for each COS domain.
Ethical approval was provided by the University of Plymouth Research Ethics Committee for the qualitative interview study (ID5116), e-Delphi study and consensus meeting (ID5636). Study findings will be published open access in a peer-reviewed journal and presented at relevant national and international conferences.
COMET registration: 2590 (https://www.comet-initiative.org/Studies/Details/2590)
CRD42024562735.
Cardiovascular (CV) disease is the leading cause of morbidity and mortality globally. Low-density lipoprotein cholesterol (LDL-C) is an important modifiable risk factor of major adverse cardiovascular events. Patients without prior myocardial infarction (MI) or stroke but with established risk factors and elevated LDL-C may benefit from intensive lipid-lowering therapy (LLT); however, the size and potential healthcare burden of this population globally are not known. The benefits of evolocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, in these patients, are currently being studied in the phase 3 Effect of Evolocumab in Patients at High Cardiovascular Risk Without Prior Myocardial Infarction or Stroke (VESALIUS-CV) trial. To characterise the high-risk pre–CV-event (VESALIUS-CV–like) individuals in the real world, an observational study is being conducted across multiple countries.
This retrospective cohort study will use a common protocol and an analytical common data model approach to characterise VESALIUS-CV–like individuals in the real world across different geographical regions and healthcare settings. The study period will be from 2010 to 2022, subject to data availability in study sites. Patients aged 50 years and older at high risk of CV disease but without prior MI or stroke will be included in this study. VESALIUS-CV–like individuals are defined through a combination of the following: (1) one diagnosis of coronary artery disease, cerebrovascular disease, peripheral artery disease or diabetes with microvascular complications or chronic insulin use; (2) an elevated LDL-C measurement and (3) other high-risk factors. The objectives of this study are to estimate the prevalence of VESALIUS-CV–like individuals, describe their characteristics and care pathways and estimate their incidence rates of CV events and healthcare costs. The prevalence of VESALIUS-CV–like individuals will be expressed as annual prevalence; patient characteristics at index date will be presented using summary statistics; care pathways will be summarised as LLT prescription across time; and the incidence of defined CV events will be expressed as events per person-years as well as at certain time periods. Healthcare costs will be presented as CV-related costs in different time periods.
Approvals of the study protocol were obtained from relevant local ethics and regulatory frameworks for each participating database. The results of the study will be submitted to peer-reviewed scientific publications and presented at scientific conferences.
To evaluate whether remdesivir is associated with cardiac adverse events (CAEs), addressing concerns raised by basic experiments, clinical case reports and observational studies.
Systematic review and meta-analysis.
MEDLINE and Embase, searched from January 2020 to December 2023.
Randomised controlled trials (RCTs) comparing remdesivir with placebo or standard care in patients with COVID-19, with a primary focus on cardiac safety.
We included RCTs that evaluated the safety of remdesivir in patients with COVID-19 . Eligible studies were those that compared remdesivir with placebo or standard care in adult patientsCOVID-19 . Inclusion criteria emphasised safety outcomes, particularly CAEs, as primary endpoints.
Two reviewers independently extracted data. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Harms guidelines. Risk of bias (RoB) was assessed using the Cochrane Collaboration tool. A random-effects model was used for data synthesis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to assess the certainty of evidence. The primary outcome was the incidence of any CAEs, defined as a composite of all reported cardiac-related harms. Secondary outcomes included specific CAEs such as arrhythmias, heart failure and myocardial disorders.
We identified 1698 studies, of which seven RCTs met the inclusion criteria, comprising a total of 4566 participants. The RoB was assessed across multiple domains, with four RCTs showing low risk and three showing moderate risk in specific areas. Pooled analysis revealed no significant association between remdesivir use and CAEs (RR=0.84, 95% CI: 0.68 to 1.04, p=0.118). Subgroup analyses showed consistent findings across different patient demographics and comorbidities. GRADE assessment indicated moderate certainty for overall CAEs, low certainty for arrhythmias and heart failure (due to imprecision and study-level bias), and very low certainty for myocardial disorders (due to small sample size and indirectness).
Contrary to preliminary concerns and case reports, our meta-analysis found no evidence of a statistically significant association between remdesivir and CAEs among patients with COVID-19 . These findings provide reassurance to clinicians regarding the safety profile of remdesivir in this patient population, supporting its use as an antiviral therapy in the treatment of COVID-19. Further research is warranted to validate these findings and to clarify whether remdesivir may have a neutral or potentially protective effect on cardiac outcomes.
CRD42022383647.
To develop a concise Consensus Statement on the management of venous leg ulcers (VLUs) that incorporates existing standards and guidance on new technology, including improvement of calf muscle pump function and the utilisation of advanced wound therapies. A multidisciplinary panel of 19 wound healthcare providers from across Canada, who treat patients with VLUs, was formed. A draft document was created and four rounds of consultation and feedback were sought from the panel. The Consensus Statement was completed in June 2024 with 100% consensus on 20 sections and > 85% consensus on the remaining three sections. The key elements are—Clinical assessment and investigations; Treatment-compression to improve calf muscle pump function, and wound treatment with the principles of Wound Bed Preparation; When not healing or only suboptimal compression can be used - add treatment with muscle pump activator by continuous Neuromuscular Electrical Stimulation of the common peroneal nerve to improve calf muscle pump function; When VLUs are not healing with optimal therapy - an algorithm for the use of advanced wound therapies; and Prevention of VLU recurrence. The Consensus Statement is a concise guide for healthcare providers to use at the bedside and has been endorsed by leading nursing and homecare associations in Canada that also have physician representation.
This study describes characteristics and factors associated with cutaneous manifestations of COVID-19 encountered across acute inpatient, and critical care units in a large Southeastern USA public hospital from March 1, 2020, through November 01, 2021. A retrospective descriptive analysis was conducted on a purposive sample of patients consulted for non-pressure injury related cutaneous wounds while positive for COVID-19. Patients were predominantly male (64.3%, n = 27), White (66.7%, n = 28) and Black (33.3%). No cutaneous wounds while positive for COVID-19 were observed for Hispanic patients. Patient mortality was 71.4% (n = 30). Gender distribution was proportionate by gender (67% were male) and race (65.5% were White) for deceased patients. Body mass index (BMI) ranged from 15.8 to 61.2 with a mean of 31.9 (SD = 10.76) and median BMI 28.7. Identification of cutaneous manifestations of COVID-19 and understanding of the retiform purpura pathophysiology could prove useful in guiding COVID-19 treatment regimens. Investigation into factors preventing complement cascading in those of Hispanic ethnicity may be useful in the prevention of CMC-19 and progression of severity of illness.
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