Leduc Community Hospital

<h3>BACKGROUND:</h3> Frailty is a state of vulnerability to diverse stressors. We assessed the impact of frailty on outcomes after discharge in older surgical patients. <h3>METHODS:</h3> We prospectively followed patients 65 years of age or older who underwent emergency abdominal surgery at either of 2 tertiary care centres and who needed assistance with fewer than 3 activities of daily living. Preadmission frailty was defined according to the Canadian Study of Health and Aging Clinical Frailty Scale as “well” (score 1 or 2), “vulnerable” (score 3 or 4) or “frail” (score 5 or 6). We assessed composite end points of 30-day and 6-month all-cause readmission or death by multivariable logistic regression. <h3>RESULTS:</h3> Of 308 patients (median age 75 [range 65–94] yr, median Clinical Frailty Score 3 [range 1–6]), 168 (54.5%) were classified as vulnerable and 68 (22.1%) as frail. Ten (4.2%) of those classified as vulnerable or frail received a geriatric consultation. At 30 days after discharge, the proportions of patients who were readmitted or had died were greater among vulnerable patients (<i>n</i> = 27 [16.1%]; adjusted odds ratio [OR] 4.60, 95% confidence interval [CI] 1.29–16.45) and frail patients (<i>n</i> = 12 [17.6%]; adjusted OR 4.51, 95% CI 1.13–17.94) than among patients who were well (<i>n</i> = 3 [4.2%]). By 6 months, the degree of frailty independently and dose-dependently predicted readmission or death: 56 (33.3%) of the vulnerable patients (adjusted OR 2.15, 95% CI 1.01–4.55) and 37 (54.4%) of the frail patients (adjusted OR 3.27, 95% CI 1.32–8.12) were readmitted or had died, compared with 11 (15.3%) of the patients who were well. <h3>INTERPRETATION:</h3> Vulnerability and frailty were prevalent in older patients undergoing surgery and unlikely to trigger specialized geriatric assessment, yet remained independently associated with greater risk of readmission for as long as 6 months after discharge. Therefore, the degree of frailty has important prognostic value for readmission. <h3>Trial registration for primary study</h3> ClinicalTrials.gov, no. NCT02233153

Duncan, D. C., and J. H. Devries. 2018. Agricultural destruction of Northern Pintail nests on cropland in prairie Canada. Avian Conservation and Ecology 13(2):6. https://doi.org/10.5751/ACE-01243-130206

Progressive multifocal leukoencephalopathy (PML) is an increasingly common and rapidly fatal demyelinating infection of central nervous system caused by the highly prevalent John Cunningham (JC) virus in immunocompromised individuals belonging to all age groups and genders. Human immunodeficiency virus (HIV) is the most common predisposing factor among other immunodeficient conditions leading to reactivation and multiple neurological symptoms. It has varied findings on magnetic resonance imaging (MRI) and diagnosis is confirmed by positive JC virus in cerebrospinal fluid (CSF). We report 12 confirmed cases of PML from a single academic center. We comprehensively described clinical presentations, risk factors, CSF and neuroimaging findings, treatment and outcome for these cases of PML, a rare disease. The cases were almost equivalently distributed among young and old age groups and both genders. Positive JC virus on CSF was present in the majority of cases along with mild to severe reduction in lymphocyte counts. Significant MRI changes were present in all cases ranging from T2 hypertense signals to white matter lesions in various regions. Treatment with the reversion of immune-modulators, optimization of antiviral therapy (ART), plasmapheresis (PLEX), IVIG, Mirtazapine, oral steroids, and others was started as soon as the diagnosis was made in the majority of the cases. However, PML is a rapidly fatal illness and hence, survival was only seen in 4 cases in our study. The objective of this article is to highlight the importance of early diagnosis of PML with CSF findings and neuroimaging, early reversion of immunosuppressive medications, and careful monitoring and treatment of HIV cases with goals to reduce mortality, long-term morbidity, and deficits.

Simple febrile seizures last for less than 10 minutes and resolve spontaneously, in the context of a febrile illness, without focal features or recurrence during the subsequent 24 hours. We report the case of fortuitous video-EEG recording of a FS, clinically classified as "simple", which demonstrated a focal, temporal onset. This clinical finding is in agreement with animal model studies demonstrating focal onset.

Abstract Background Stress hyperglycemia can persist during an intensive care unit (ICU) stay and result in prolonged requirement for insulin (PRI). The impact of PRI on ICU patient outcomes is not known. We evaluated the relationship between PRI and Day 90 mortality in ICU patients without previous diabetic treatments. Methods This is a post hoc analysis of the CONTROLING trial, involving 12 French ICUs. Patients in the personalized glucose control arm with an ICU length of stay ≥ 5 days and who had never previously received diabetic treatments (oral drugs or insulin) were included. Personalized blood glucose targets were estimated on their preadmission usual glycemia as estimated by their glycated A1c hemoglobin (HbA1C). PRI was defined by insulin requirement. The relationship between PRI on Day 5 and 90-day mortality was assessed by Cox survival models with inverse probability of treatment weighting (IPTW). Glycemic control was defined as at least one blood glucose value below the blood glucose target value on Day 5. Results A total of 476 patients were included, of whom 62.4% were male, with a median age of 66 (54–76) years. Median values for SAPS II and HbA1C were 50 (37.5–64) and 5.7 (5.4–6.1)%, respectively. PRI was observed in 364/476 (72.5%) patients on Day 5. 90-day mortality was 23.1% in the whole cohort, 25.3% in the PRI group and 16.1% in the non-PRI group ( p &lt; 0.01). IPTW analysis showed that PRI on Day 5 was not associated with Day 90 mortality ( IPTW HR = 1.22; CI 95% 0.84–1.75; p = 0.29), whereas PRI without glycemic control was associated with an increased risk of death at Day 90 ( IPTW HR = 3.34; CI 95% 1.26–8.83; p &lt; 0.01). Conclusion In ICU patients without previous diabetic treatments, only PRI without glycemic control on Day 5 was associated with an increased risk of death. Additional studies are required to determine the factors contributing to these results.

This study compared pregnancy per TAI (P/TAI) between sex-selected and conventional semen in cyclic beef heifers subjected to the modified (without initial GnRH) 5-day Co-synch protocol and evaluated the usefulness of an oestrus detection (ED) to identify heifers that were most likely to conceive. Heifers (n = 1034; 13 to 15 months of age) at three locations were scanned by ultrasonography to determine cyclicity (presence of corpus luteum) and reproductive tract normalcy. Cyclic heifers (n = 940) received a 1.38-g progesterone-releasing device (CIDR; Zoetis Animal Health, Florham Park, NJ, USA) on Day 0, CIDR removal and 500 µg of cloprostenol (Estroplan; Vetoquinol NA Inc., Edmonton, AB, Canada) on Day 5, and 100 µg of GnRH (Fertiline; Vetoquinol NA Inc.) along with TAI on Day 8 (72 ± 1 h after CIDR removal). On Day 5, heifers received ED patches (EstrotectTM; Estrotect Inc.) that were scored from 0 to 3, based on colour change between initial application and Day 8; 0 = unchanged, 1 = =50% colour change, 2 = &amp;gt;50% colour change, 3 = missing. Heifers were assigned by ear-tag number to be inseminated with frozen–thawed sex-selected or conventional semen from either of two sires available commercially. Pregnancy diagnosis was performed by transrectal ultrasonography 28 (herd A) or 48 (herds B and C) days after TAI. Data were analysed using the PROC GLIMMIX in SAS (SAS Institute Inc., Cary, NC, USA), with herd included as a random effect. The CIDR retention rate was 98%; P/TAI in heifers that lost the CIDR was 21%. Pregnancy per TAI [% (no.)] did not differ (P &amp;gt; 0.05) between sires [58.4 (426) v. 58.0 (414) for sires A and B, respectively], but it was higher (P &amp;lt; 0.01) for conventional semen [63.7 (422) v. 52.6 (418)]. An interaction between sire and type of semen (P = 0.07) revealed that sex-selected semen from bull B had the lowest P/TAI [49.3 (203)]. Overall, heifers with an ED patch scored 2 had greater (P &amp;lt; 0.01) P/TAI [64.8 (526)] than those scored 0 [42.9 (170)] or 1 [46.8 (79)]. Heifers with a missing ED patch had intermediate P/TAI [58.5 (65)]. However, the effect of ED patch scoring on P/TAI depended on type of semen. In heifers inseminated with conventional semen, PTAI was significantly lower (P &amp;lt; 0.01) in those with an ED patch scored 0 [49.4(87)] compared to those with a patch scored 2 [69.6 (270)]. In heifers inseminated with sex-selected semen, P/TAI was significantly lower (P &amp;lt; 0.05) in those with an ED patch scored 0 [36.1(83)] or 1 [37.2 (43)] compared with those scored 2 [59.8 (256)] or 3 [58.3 (36)]. In summary, P/TAI was greater in heifers inseminated with conventional semen. However, the P/TAI obtained with the modified GnRH-based TAI protocol in cyclic heifers inseminated with sex-selected semen was encouraging. In addition, the Estrotect oestrus detection patches were considered useful to identify animals for TAI with sex-selected semen and could be used to increase the adoption of this technology in beef herds. This study was supported by Alberta Agriculture and Forestry, Vetoquinol NA Inc., Estrotect Inc. and collaborative beef producers.

Very little is known about the current status of geriatric training programs at Canadian universities because of the scarcity of information published on the subject. A study of the geriatric dentistry training programs offered by Canada's 10 dental schools has been completed. Its intent was to determine what type of educational activities in geriatric dentistry have either been offered in the past, are being offered now, will be offered in the next academic year, or are planned for the next five years. The results indicate that the 10 schools are doing very little in this regard. To keep pace with the level of geriatric dentistry training currently being offered in the United States, the dental profession must convince Canadian faculty members that the teaching of geriatric dentistry is crucial to both the undergraduate student and the graduate dentist. Continuing education in geriatric dentistry could be used to meet the oral health needs of our frail and dependent senior citizens. Geriatric dentistry must be taught at all levels of the profession so that this special clientele can receive the necessary treatment either within or outside of the dental office.

BACKGROUND: The Mother Infant Care Center at Fort Belvoir Community Hospital (FBCH) recently revised its asymptotic neonatal hypoglycemia (ANH) protocol and adopted 40% glucose gel into its treatment pathway. The previous protocol used infant formula as the primary intervention. PURPOSE: To evaluate the effectiveness of 40% glucose gel on exclusive human milk diet rates, time on protocol, level II Special Care Nursery (SCN) admission rates, length of stay (LOS), and total hospital costs for newborns with ANH at FBCH. METHODS: Infants with ANH were treated with 40% glucose gel (n = 35) and compared with a historical group of infants with ANH (n = 29) who were treated with formula. RESULTS: Exclusive human milk diet rates increased by 33.6%. The mean time on protocol dropped by 1.13 hours. The SCN admission rates dropped by 2.4% in the postimplementation group. The mean LOS was more than 12 hours less in the postimplementation group. The mean total cost per patient was $1190.60 lower after implementation of 40% glucose gel. IMPLICATIONS FOR PRACTICE: The use of 40% glucose gel is a patient-focused, less-invasive, and cost-effective treatment of ANH. IMPLICATIONS FOR RESEARCH: More studies are needed to better define neonatal hypoglycemia. The use of 40% glucose gel is safe for use in infants with ANH; however, more studies are needed to examine its comprehensive benefits.

We have shown that inclusion of initial gonadotropin-releasing hormone (GnRH) in a 5-day Co-synch protocol is unnecessary to achieve acceptable pregnancy rates in dairy heifers (2011 Theriogenology 76, 578). This study determined the efficacy of a modified (without initial GnRH) 5-day Co-synch protocol for timed AI (TAI) and the effect of interval from progesterone device removal to TAI on pregnancy per TAI (P/TAI) in acyclic and cyclic beef heifers. Heifers (n = 1062; 302 to 515 kg of body weight, and 13 to 15 months of age) at 2 locations were assigned to either a 5-day Co-synch protocol with (control) or without (modified) an initial injection of 100 µg of GnRH (Fertagyl; Merck Animal Health, Kenilworth, NJ, USA) at progesterone device (CIDR; Zoetis Animal Health, Florham Park, NJ) insertion (Day 0). All heifers received a single dose of 500 µg of cloprostenol (Estrumate; Merck Animal Health) at CIDR removal (Day 5) and were divided into 2 groups to receive GnRH and simultaneously TAI at either 66 or 72 h (Day 8) after CIDR removal. All heifers were inseminated by one technician with frozen-thawed semen from 1 of 4 commercially available sires. Ovarian ultrasonography was performed on Day 0 to determine cyclicity (presence of corpus luteum) and normalcy of the reproductive track, and on Day 35 (27 days after TAI) to determine pregnancy status. Data were analysed using the PROC GLIMMIX in SAS (SAS Institute Inc., Cary, NC, USA). The CIDR retention rate was 98%; P/TAI in heifers that lost the CIDR was 39%. Pregnancy per TAI [least squares means (n)] did not differ (P &amp;gt; 0.05) among sires [48 (235), 51 (318), 52 (274), and 53% (235)], location [57 (330) v. 53% (732)], timing of TAI [52 (533) v. 50% (529) for 66 and 72 h], or treatment groups [48 (525) v. 53% (537) for control and modified groups]. A total of 226 (21%) heifers were acyclic; P/TAI was lower in acyclic heifers compared with that in those cyclic (P &amp;lt; 0.01; 43 v. 59%). Administration of GnRH at CIDR insertion increased P/TAI in acyclic heifers (P &amp;lt; 0.01; 50 v. 35% for control and modified groups) but did not affect P/TAI in those that were cyclic at initiation of protocol (P &amp;gt; 0.05; 57 v. 62% for control and modified groups). In conclusion, timing of TAI did not affect fertility. However, administration of initial GnRH increased P/TAI by 15 percentiles in acyclic females, but as previously shown in Holstein heifers, initial GnRH was unnecessary to achieve acceptable P/TAI in cyclic beef heifers subjected to a 5-days Co-synch protocol. This study was supported by Alberta Agriculture and Forestry, Intervet Canada Corp., and collaborative beef producers.

The impact of

Background: In France, there were an estimated 18.000 incident lymphoma cases in 2018. Currently, most of the knowledge comes from clinical trials (CT), with stringent inclusion criteria and poor representativeness. Real world data (RWD) is essential to complement CT data, but major challenges such as feasibility and data quality remain. In this context, the REal world dAta in LYmphoma and Survival in Adults (REALYSA) multicentric prospective cohort started in 2018 (NCT03869619), with a recruitment objective of 6000 patients and a 9-year follow-up (FU). Aims: The aims of this study are (i) to evaluate the capacity of a real-world program to provide high-quality data that translate into meaningful clinical endpoints, and (ii) to describe the demographic and clinical characteristics as well as therapeutic management and treatment effectiveness of 1st line (1L) DLBCL patients. Methods: Patients diagnosed with 7 histological lymphoma subtypes are included in REALYSA at diagnosis after signing informed consent. Patients receive standard routine care. Data collection includes demographic, clinical, quality of life and epidemiological data at inclusion and every 6 to 12 months. A biobank is also constituted. A strong data validation system inspired from clinical research standards, including care pathway visualisation tools, is regularly running. Meaningful real-life endpoints were derived, such as end of treatment (EoT) evaluation and event-free survival (EFS). We present here the results of a proof-of-concept analysis for REALYSA patients with a DLBCL diagnosis and who received a 1L treatment. Results: Thirty-five hospitals/clinics are currently participating to REALYSA across France. As of Jan 31st 2022, 1217 patients with DLBCL were included in REALYSA with a mean number of 60 patients per month; 645 epidemiological questionnaires were collected; and there were more than 1500 samples in the biobank. The analysis was conducted on 645 DLBCL patients included in REALYSA before March 31st 2021. Median age was 66.3 years [54-75]. Most patients were male (344; 53.3%), with advanced-stage disease (Ann-Arbor stage III/IV for 472 patients (73.3%)), extra-nodal locations (499; 77.4%) and elevated LDH level (402; 64.0%). The international prognostic index was 2 to 5 for 486 patients (76.2%). Treatments received at 1L were R-CHOP (482; 74.7%), R-miniCHOP (86; 13.3%), high dose anthracycline-based regimen (62; 9.6%) and non-anthracycline based regimen (15; 2.3%). Among patients with EoT evaluation done (603), 483 (80.1%) had a complete response, 51 (8.5%) a partial response, 7 (1.2%) a stable disease and 62 (10.3%) a progressive disease. Of note, EoT evaluation was performed by PET/scan for 92% of patients. Median FU was 9.9 months [4.5-17.2]. Results for effectiveness at 12 months were: (i) EFS of 77.9% [95% CI 73.8-81.4]; (ii) PFS of 79.7% [75.6-83.1]; and (iii) overall survival of 90.0% [86.5-92.5]. With the limitation of the short FU, and using backward stepwise regression model, we confirmed that EFS was associated with age, ECOG PS, LDH level and bulk disease. Summary/Conclusion: This analysis showed that REALYSA, the first nationwide real-life cohort on lymphoma, is able to provide high-quality data, with results for 1L DLBCL patients consistent with the literature, including recent phase 3 trials. These data will be useful for numerous purposes, including a better characterization of lymphoma population in France (clinic, epidemiology, biology), as well as innovative study designs (e.g. new outcome endpoints, synthetic control arm).

This study compared reproductive outcomes among two protocols for synchronization of ovulation that provide for a lengthened proestrus with the conventional oestradiol-based protocol currently used for timed-AI (TAI). Holstein heifers (13-15 months) at one location were assigned randomly to one of three TAI protocols. Heifers (n = 150) in the 7-day oestradiol benzoate (EB) group received a progesterone device (Cue-Mate) and 2 mg EB on Day 0; 500 μg of cloprostenol (PGF) and Cue-Mate removal on Day 7; 1 mg of EB on Day 8 and TAI on Day 9 (54 h after Cue-Mate removal). Heifers (n = 150) in the 5-day CO-Synch (CO) group received a Cue-Mate and 100 μg of gonadotropin-releasing hormone (GnRH) on Day 2; Cue-Mate removal and PGF (twice, 12 h apart) on Day 7; and GnRH along with TAI on Day 10 (72 h after Cue-Mate removal). Heifers (n = 150) in the J-Synch (JS) group received a Cue-Mate and 2 mg of EB on Day 1; PGF and Cue-Mate removal on Day 7; GnRH and TAI on Day 10 (72 h after Cue-Mate removal). Heifers were inseminated by one technician with frozen-thawed conventional semen from one of four commercially available sires. Plasma progesterone (P4) concentrations (ng/mL) were determined at Cue-Mate removal and TAI. Ovarian ultrasonography was done in a subset of 217 heifers at the initiation of protocols, at Cue-Mate removal; TAI; and 7 days after TAI. Approximately, 28 and 50 days after TAI pregnancy status was determined by ultrasonography. Mean (±SEM) plasma P4 concentration at Cue-Mate removal was greater (p < .01) in CO (6.02 ± 0.2) and JS (6.51 ± 0.2) compared to EB heifers (4.53 ± 0.2). Mean (±SEM) plasma P4 concentration at TAI was lowest in the JS (0.28 ± 0.05), intermediate in CO (0.46 ± 0.02), and greatest in EB heifers (0.66 ± 0.05, p < .01). The diameter of the ovulatory follicle (mean ± SEM) was the smallest in the JS group compared to that in the CO and EB groups (15.8 ± 0.5; 13.9 ± 0.5; and 12.7 ± 0.5 mm for EB, CO and JS, respectively). More (p < .01) heifers in the JS group had their oestrous cycle synchronized (50.0, 78.8 and 82.4% for EB, CO and JS groups), and were pregnant at 28 (40.3, 51.3 and 63.3% for EB, CO and JS groups) and 50 days after TAI (32.6, 46.0 and 60.0% for EB, CO and JS groups). In summary, heifers subjected to the J-Synch TAI protocol had lower P4 at TAI, and better overall response to hormonal treatments, which resulted in increased P/AI at 28 and 50 days after TAI compared to those heifers subjected to either a 7-day EB protocol or a 5-day CO-synch protocol.

Reproduction, Fertility and Development is an international journal publishing original research , review and comment in the fields of reproduction and developmental biology in humans, domestic animals and wildlife

Canada's decriminalisation of assisted death has elicited significant ethical implications for the use of assisted death in healthcare contexts. Euthanasia by removal of vital organs (ERVO) is a theoretical extension of medically assisted death with an increased plausibility of implementation in light of the rapid expansion of assisted death eligibility laws and criteria in Canada. ERVO entails removing organs from a living patient under general anaesthesia as the mechanism of death. While ERVO is intended to maximise the viability of organs procured from the euthanised patient for donation to recipients, ending the lives of patient donors in this manner solely to benefit ill or dying recipient patients merits further ethical consideration. Specifically, the paper explores the application of personalist bioethics in determining whether the means of procuring organs through assisted death justifies the end of improving the lives of those who would benefit from receiving them. Further, by discussing the medical, social and ethical implications of ERVO, I will explicate a broader philosophical understanding of the influences of legalising assisted death on human dignity and conscience.

JOBST® FarrowWrap® is indicated in patients presenting with venous leg ulceration in combination with mild-to-moderate oedema. These symptoms result in significant physical and psychological problems and management can be costly in terms of duration of input and resources. This article will present four case studies demonstrating the benefits and outcomes for patients with lower limb issues and will consider how the product helps improve shape, reduce oedema, heal ulceration, improve quality of life in relation to the lower limb and encourage self-care.

Delayed cord clamping (DCC) for up to 3 minutes has been found to improve in-patient outcomes in very preterm infants (Rabe 2008). The impact on neurodevelopmental impairment (NDI) is uncertain. This retrospective study aimed to determine if there is an association between DCC and the incidence of severe NDI or death. Data were abstracted from Neonatal Unit and Follow-Up databases for babies born 3 std. dev. below mean and Bayley III scores 2–3 std. dev. below mean. Severe neurological impairment defined as: non-ambulatory cerebral palsy (GMFCS 3–5) composite Bayley III developmental scores >3 std. dev. below mean legal blindness hearing loss requiring hearing aids or cochlear implant 2+ moderate disabilities Of 227 babies eligible for DCC, 166 (73%) received DCC for ≥45 seconds and 61 (27%) did not receive DCC for ≥45 seconds. No differences in gestational age, birth weight, gender, mode of delivery, admission temperature and highest serum bilirubin were found between DCC and immediate clamping (ICC) groups. Scores of illness severity did not differ between the DCC and ICC groups either. No significant difference in the incidence of severe NDI or death was found when babies who received DCC were compared to those who received ICC. Rates of survival without severe NDI were 142 infants out of 166 and 54 out of 61 for DCC and ICC, respectively (P=0.56). Secondary outcomes were also unaffected by DCC. This is the first study to look at 18 month outcomes following DCC. We found that DCC is not associated with improved or worse outcomes compared to ICC. Rates of survival without severe NDI are low in babies eligible for DCC and are not associated with DCC vs. ICC. The causes of NDI are multifactorial and may not be influenced by a single perinatal factor. Our analysis is limited by a small sample size due to the low rate of severe NDI in the cohort.