Lloydminster Hospital

AIMS: Opioid misuse and overuse have contributed to a widespread overdose crisis and many patients and physicians are considering medical cannabis to support opioid tapering and chronic pain control. Using a five-step modified Delphi process, we aimed to develop consensus-based recommendations on: 1) when and how to safely initiate and titrate cannabinoids in the presence of opioids, 2) when and how to safely taper opioids in the presence of cannabinoids and 3) how to monitor patients and evaluate outcomes when treating with opioids and cannabinoids. RESULTS: In patients with chronic pain taking opioids not reaching treatment goals, there was consensus that cannabinoids may be considered for patients experiencing or displaying opioid-related complications, despite psychological or physical interventions. There was consensus observed to initiate with a cannabidiol (CBD)-predominant oral extract in the daytime and consider adding tetrahydrocannabinol (THC). When adding THC, start with 0.5-3 mg, and increase by 1-2 mg once or twice weekly up to 30-40 mg/day. Initiate opioid tapering when the patient reports a minor/major improvement in function, seeks less as-needed medication to control pain and/or the cannabis dose has been optimised. The opioid tapering schedule may be 5%-10% of the morphine equivalent dose (MED) every 1 to 4 weeks. Clinical success could be defined by an improvement in function/quality of life, a ≥30% reduction in pain intensity, a ≥25% reduction in opioid dose, a reduction in opioid dose to <90 mg MED and/or reduction in opioid-related adverse events. CONCLUSIONS: This five-stage modified Delphi process led to the development of consensus-based recommendations surrounding the safe introduction and titration of cannabinoids in concert with tapering opioids.

Background and Purpose: Improving door-to-needle times (DNTs) for thrombolysis of acute ischemic stroke patients improves outcomes, but participation in DNT improvement initiatives has been mostly limited to larger, academic medical centers with an existing interest in stroke quality improvement. It is not known whether quality improvement initiatives can improve DNT at a population level, including smaller community hospitals. This study aims to determine the effect of a provincial improvement collaborative intervention on improvement of DNT and patient outcomes. Methods: A pre post cohort study was conducted over 10 years in the Canadian province of Alberta with 17 designated stroke centers. All ischemic stroke patients who received thrombolysis in the Canadian province of Alberta were included in the study. The quality improvement intervention was an improvement collaborative that involved creation of interdisciplinary teams from each stroke center, participation in 3 workshops and closing celebration, site visits, webinars, and data audit and feedback. Results: Two thousand four hundred eighty-eight ischemic stroke patients received thrombolysis in the pre- and postintervention periods (630 in the post period). The mean age was 71 years (SD, 14.6 years), and 46% were women. DNTs were reduced from a median of 70.0 minutes (interquartile range, 51–93) to 39.0 minutes (interquartile range, 27–58) for patients treated per guideline ( P &lt;0.0001). The percentage of patients discharged home from acute care increased from 45.6% to 59.5% ( P &lt;0.0001); the median 90-day home time increased from 43.3 days (interquartile range, 27.3–55.8) to 53.6 days (interquartile range, 36.8–64.6) ( P =0.0015); and the in-hospital mortality decreased from 14.5% to 10.5% ( P =0.0990). Conclusions: The improvement collaborative was likely the key contributing factor in reducing DNTs and improving outcomes for ischemic stroke patients across Alberta.

The Family Management Style Framework (FMSF) was used as a conceptual basis for secondary data analysis of 55 previously conducted interviews with mothers and fathers of children with a lethal congenital condition from two surgical treatment eras. The directed content analysis was guided by a coding structure developed from family management dimensions identified in prior research of family response to childhood chronic conditions. Results indicated that application of the FMSF was helpful in differentiating families and their processes of family management at the onset of their infant’s illness through to surviving the first surgery and going home. The dimensions of Illness View and Child Identity were central to the parents’ capacity to manage their baby’s illness demands within their family context. Applying a robust family framework to a complex neonatal condition at illness onset provides compelling direction for clinical interventions and their rigorous evaluation.

Abstract: Evaluation designs that can capture the complexity of health promotion (HP) interventions are needed. Our objective was to assess if such evaluations use a Complex Adaptive Systems (CAS) perspective, by using a scoping review of evaluations of HP interventions concerning alcohol and tobacco use in the peer-reviewed (PR) and grey literature (GL). We developed indicator questions to assess CAS aspects. Our study revealed that none of the 45 PR and 9 GL evaluations that we reviewed explicitly used a CAS perspective; however, most indirectly assessed complexity aspects. Our indicator questions are a step toward addressing the challenges of the practical application of a CAS perspective.

Abstract The induced air flotation (IAF) of a highly stabilized oil in water (o/w) emulsion has been studied experimentally in a batch column 10 cm in diameter and 150 cm in height. Column performance was strongly affected by the method of air distribution. The main variables investigated were the type of air distributor (either porous plate, single hole plate, or multi‐hole plate), initial oil concentraton (30‐600 mg/L), oil drop size distribution of feed (1.0‐30 μm), surfactant type, and gas superficial velocity. Results were successfully analyzed in terms of a first order kinetic rate model which yielded a removal rate constant ( K 1 ) that varied from 2.0 to 60.0 h −1 . Corresponding total organic carbon (TOC) removal efficiencies went from 20 to 99.9 percent, illustrating the wide performance range for the flotation cell.

A naturally occurring subspecies hybrid of the type Brassica campestris ssp. sarson Prain. ’R-500’ × B. campestris L. var. oleifera Metzg. was identified. Hybrid seed borne on R-500 plants is larger and more darkly pigmented than seed from self- and sib pollinations of R-500. Of 77 seeds selected on the basis of diameter and testa color, 60 had erucic acid levels indicating that they were hybrids between R-500 and an unknown low erucic acid type. The hybrid yielded 146% of the B. campestris var. oleifera ’Candle’ in a replicated test. Oil content of the hybrid was 2.6% lower than Candle but protein content was 4.1% higher. Yield of oil and protein per hectare was 137% and 160% of Candle, respectively. Seed borne on the hybrid is brown but crude fiber content of the meal is not significantly different from the yellow-seeded, low fiber cultivar Candle. Seed produced on hybrid plants has high erucic acid oil (28.9%) and high glucosinolate meal (95.5 μm/g). Days to maturity of the hybrid is intermediate between B. campestris and B. napus.

OBJECTIVE: The 22q11.2 deletion syndrome is among the most common head-and-neck-related syndromes. The literature has examined many of the phenotypic features of 22q11.2 deletion syndrome; however, few studies have explored the manifestation of cervical spine abnormalities. In this study, we compared the cervical spines of individuals with and without 22q11.2 deletion syndrome using diagnostic imaging. DESIGN: A retrospective case-control study, with age- and sex-matched control participants who underwent flexion/extension x-rays and either a computed tomography or MRI scan. SETTING: PARTICIPANTS presented to the velopharyngeal insufficiency clinic at Victoria Hospital in London, Ontario, Canada, a tertiary care center. PARTICIPANTS: Sixteen pediatric patients (<age 18 at presentation) who had genetically confirmed 22q11.2 deletion syndrome were age- and sex-matched to 16 patients who presented with head and neck trauma without radiographic evidence of injury to the cervical spine. The mean age was 11.7 years (range, 2 to 21 years). MAIN OUTCOME MEASURE: Radiographic evidence of cervical spine abnormalities ± evidence of instability. RESULTS: Patients with 22q11.2 deletion syndrome were significantly more likely to have an open posterior arch of C1 (P < .0001), anterior arch cleft of C1 (P < .0001), and platybasia (P = .001). There was also a positive trend for fusion of the C2-C3 vertebrae (P = .051). CONCLUSION: Significant differences in radiographic cervical spine measurements were found between 22q11.2 deletion syndrome patients and controls. Cervical spine abnormalities are common phenotypic features of 22q11.2 deletion syndrome, but the clinical consequences are poorly understood. Further investigation is necessary to understand the possible ramifications of these abnormalities, including precautions during medically necessary interventions, and lifestyle limitations for these individuals.

This study was carried out in an oilfield waterflood operation in which produced brine is reinjected to displace oil from the reservoir. Significant corrosion problems are associated with bacterial colonization of the water handling system. Previous work has focused on optimizing biocide treatments, but there are limits to what is economically achievable by this approach. This report describes results of an audit of chemical, biological and corrosion parameters measured across the Wainwright waterflood operation over a 30-month period. The intent of the audit was to provide a basis for understanding and improving monitoring and control practices in such operations. Corrosion-monitoring methods generally failed to correlate in a simple way with corrosion failures. Failure frequency correlated with several water chemistry parameters. Common treatment chemicals showed evidence of promoting bacterial growth. Sulfate-reducing bacterial numbers were found to be a function of position in the system, population composition and water chemistry. Based on the insights obtained, a series of runs was carried out in a special test facility to assess the effects of trace nitrate, oxygen scavenger, and nutrient addition on the sessile bacterial populations present in an operating unit. Results are briefly described.

There have been numerous concerns about the disease and how it affects the human body since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began in December 2019. The impact of SARS-CoV-2 on the liver is being carefully investigated due to an increase in individuals with hepatitis and other liver illnesses, such as alcoholic liver disease. Additionally, the liver is involved in the metabolism of numerous drugs used to treat comorbidities and coronavirus disease 2019 (COVID-19). Determining how SARS-CoV-2 affects the liver and what factors place individuals with COVID-19 at a higher risk of developing liver problems are the two main objectives of this study. This evaluation of the literature included research from three major scientific databases. To provide an update on the current impact of COVID-19 on the liver, data was collected and relevant information was incorporated into the review. With more knowledge about the effect of the disease on the liver, better management and therapeutics can be developed, and education can ultimately save lives and reduce the long-term impact of the pandemic on our population.

Background: Opioid analgesics are high-alert medications known to cause adverse drug events.Objectives: The purpose of this study was to determine the cause of opioid incidents requiring administration of naloxone, an opioid reversal agent. The specific objectives were to determine the number of opioid incidents and the proportion of incidents documented through occurrence reporting and to characterize the incidents by phase in the medication-use process, by type of incident, and by drug responsible for toxic effects.Methods: A retrospective chart analysis was conducted using records from 2 acute care centres in the Regina Qu’Appelle Health Region. The study included inpatients who received naloxone for reversal of opioid toxicity resulting from licit, in-hospital opioid use. Cases were classified as preventable or nonpreventable. Preventable cases were analyzed to determine the phase of the medication-use process during which the incident occurred. These cases were also grouped thematically by the type of incident. The drug most likely responsible for opioid toxicity was determined for each case. The proportion of cases documented by occurrence reporting was also noted.Results: Thirty-six cases involving administration of naloxone were identified, of which 29 (81%) were deemed preventable. Of these 29 preventable cases, the primary medication incident occurred most frequently in the prescribing phase (23 [79%]), but multiple phases were often involved. The cases were grouped into 6 themes according to the type of incident. Morphine was the drug that most frequently resulted in toxic effects (18 cases [50%]). Only two of the cases (5.6%) were documented by occurrence reports.Conclusion: Preventable opioid incidents occurred in the acute care centres under study. A combination of medication safety initiatives involving multiple disciplines may be required to decrease the incidence of these events and to better document their occurrence.RÉSUMÉContexte : Les analgésiques opioïdes sont des médicaments qui commandent une vigilance élevée, connus pour les événements indésirables qu’ils entraînent.Objectifs : Le but de cette étude était de déterminer la cause des incidents attribuables aux opioïdes nécessitant l’administration de naloxone, un antidote des opioïdes. Les objectifs précis étaient de déterminer le nombre d’incidents attribuables aux opioïdes et la proportion d’incidents constatés par comptes rendus d’événements et de caractériser les incidents selon la phase dans le processus de distribution des médicaments, le type d’incident et l’agent responsable des effets toxiques.Méthodes : Une analyse rétrospective des dossiers médicaux des patients a été menée dans deux centres de soins de courte durée de la Regina Qu’Appelle Health Region. L’analyse incluait les patients hospitalisés ayant reçu de la naloxone pour neutraliser la toxicité opioïde attribuable à l’utilisation intrahospitalière licite d’opioïdes. Les cas d’incidents ont été classés comme étant évitables ou non évitables. Les cas évitables ont été analysés afin de déterminer la phase du processus de distribution des médicaments durant laquelle l’incident est survenu. Ces cas ont également été regroupés par type d’incident. Le médicament le plus susceptible d’avoir causé une toxicité opioïde a été déterminé pour chaque cas. La proportion de cas constatés par comptes rendus d’événements a aussi été notée.Résultats : On a relevé 36 cas nécessitant l’administration de naloxone, dont 29 (81 %) ont été jugés évitables. De ces 29 cas évitables, le principal incident lié au médicament est survenu le plus souvent dans la phase de prescription (23 [79 %]), mais plusieurs phases étaient souvent en cause. Les cas ont été regroupés en six types d’incidents. La morphine était l’agent ayant le plus souvent entraîné des effets toxiques (18 cas [50 %]). Seulement deux des cas (5,6 %) ont été constatés par comptes rendus d’événements.Conclusion : Des incidents évitables liés aux opioïdes sont survenus dans les deux centres de soins de courte durée faisant l’objet de la présente analyse. Une combinaison de mesures faisant appel à plusieurs disciplines pour améliorer la sécurité des médicaments pourrait être nécessaire afin de réduire l’incidence de tels événements et de constater leur occurrence.

The novel coronavirus disease 2019 (COVID-19) causes serious respiratory illness and related disorders. Vulnerable populations, including those with chronic obstructive pulmonary disease, heart disease, diabetes, chronic kidney disease, obesity, and the elderly, face an increased risk of severe complications. As the pandemic evolves, various diagnostic techniques are available to detect severe acute respiratory distress syndrome (SARS-CoV-2), including clinical presentation, rapid antigen/antibody testing, molecular testing, supplemental laboratory analysis, and imaging. Based on peer-reviewed data, treatment options include convalescent plasma transfusion, corticosteroids, antivirals, and immunomodulatory medications. Convalescent plasma therapy, historically used in outbreaks like Middle East respiratory syndrome, Ebola, and SARS, is suggested by the World Health Organization for critically ill COVID-19 patients when vaccines or antiviral drugs are unavailable. Neutralizing antibodies in convalescent plasma help control viral load and improve patient outcomes, especially when administered early, though effectiveness varies. The United States Food and Drug Administration has authorized its emergency use for severe COVID-19 cases, but potential risks such as transfusion reactions and transfusion-related acute lung injury require further investigation to establish definitive efficacy. Antiviral agents like Remdesivir, an adenosine nucleotide analog, inhibit viral RNA polymerase and have shown efficacy in reducing COVID-19 severity, leading to its emergency use authorization for hospitalized patients. Other antivirals like ritonavir, lopinavir, and umifenovir disrupt viral replication and entry, but their effectiveness against SARS-CoV-2 remains under investigation. Dexamethasone, a corticosteroid, has been used in critically ill COVID-19 patients to reduce inflammation and prevent respiratory failure, as shown in the RECOVERY trial. Other immunosuppressants like ruxolitinib, baricitinib, and colchicine help modulate the immune response, reducing cytokine storms and inflammation-related complications. However, corticosteroids carry risks such as hyperglycemia, immunosuppression, and delayed viral clearance, requiring careful administration. Systematic reviews of clinical studies revealed that hydroxychloroquine with or without azithromycin did not decrease viral load nor reduce the severity of symptoms, but increased mortality among acutely hospitalized patients. There was no improvement in patients’ clinical conditions after 15 days compared to standard treatment. The United States Food and Drug Administration has revoked the authorization for the use of hydroxychloroquine in COVID-19 patients due to the null benefit-risk balance. Monoclonal antibodies like itolizumab, gimsilumab, sarilumab, and tocilizumab are being studied for their ability to reduce the severe inflammatory response in COVID-19 patients, particularly cytokine release syndrome and acute respiratory distress syndrome. These antibodies target specific immune pathways to decrease pro-inflammatory cytokines, with some showing promising results in clinical trials, though their use remains under investigation. The Clustered Regularly Interspaced Short Palindromic Repeats/Cas13 family of enzymes, sequenced from many COVID-19-positive patients, can potentially inhibit SARS-CoV-2 replication, cleave the RNA genome, and aid in the amplification of the genome assay. Cas13 can also target emerging pathogens via an adeno-associated virus vector when delivered to the infected lungs. In addition to pharmacological agents, vaccines effectively prevent symptomatic infection, reduce hospitalizations, minimize mortality rates, and ultimately reduce the severity of the disease. This paper aims to explore the management of patients with underlying conditions who present with COVID-19 to lessen the burden on healthcare systems.

Primary health care (PHC) research has been undergoing a renaissance in Canada, bolstered by evidence that PHC is the foundation of high-performing health care systems.[1][1],[2][2] There is great interest in understanding the effects of primary care reforms, such as changes in the method of

A recent Alberta teacher health study indicated that teachers on long‐term disability (LTD) benefits are, for the most part, left to their own devices regarding rehabilitation. Subsequently, the authors of that study (Jevne and Zingle, 1990) recommended the development of a “psychologically and educationally sound intervention” to assist the LTD teacher in maximizing recovery. In response to this recommendation, an adaptation of single‐session therapy was developed by Talman (1990) and a pilot intervention was carried out. Thirty‐three LTD teachers, volunteered to become part of this pilot project designed to provide individualized consultation and follow‐up based on an empowerment model. The main focus of these consultations was to determine the present state of wellness and to provide new insights and expand alternatives within a caring and safe therapeutic environment. The follow‐up debriefings and evaluations indicated that most individuals experienced substantive change in many areas of wellness during the time of the study. Without assuming direct causal relationship, it would seem that this single‐session therapy approach has potential as a model of brief intervention for the “disabled” teacher.

Introduction: In the United States, esophageal cancer represents approximately 1% of the total cancer diagnoses. In the United States, esophageal adenocarcinoma is the more frequent subtype compared to esophageal squamous cell carcinoma, comprising approximately 80% of all cases of esophageal cancer. The objective of this study was to analyze the patterns of mortality from esophageal cancer among different racial groups in the United States Methods: We conducted a retrospective analysis employing the Centers for Disease Control and Prevention's (CDC) WONDER database, which covers the entire US population. Using the multiple cause of death database (International Classification of Disease - 10th revision), we identified all patients who died of Esophageal Cancer (C15.0.x listed as the underlying cause of death) between 1999 and 2020 in the United States. Then we stratified data by race regardless of gender, and ethnic background. Age-adjusted mortality rates were calculated per 1000,000 persons (PMP) and standardized to the US census data from 2000. Results: A total of 309,919 Esophageal Cancer deaths with an overall age-adjusted mortality rate of 41.3 PMP were identified between 1999 and 2020. Race specific age-adjusted mortality were 42.6 PMP, 40.8 PMP, 25.4 PMP, and 16.6 PMP in White, Black, Asian or Pacific Islander, and American Indian or Alaska native populations, respectively. The age-adjusted mortality decreased by 5% in White (from 41.9 PMP in 1999 to 39.7 PMP in 2020), decreased by 60% in Black (from 65.3 PMP in 1999 to 26.2 PMP in 2019), decreased by 31 % in Asian/Pacific Islander (from 21.3 PMP in 1999 to 14.7 PMP in 2020), and decreased by 13% in American Indian/Alaska Native (25.9 in 1999 to 20.3 in 2020). Conclusion: Between 1999 and 2020, age adjusted mortality decreased in all races. White had the highest overall age adjusted mortality, followed by Black, Asian/Pacific Islander, and American Indian/Alaska native in descending order. Interestingly, Black showed the highest rate of decline in mortality while White showed the lowest.

Lloydminster Comprehensive High School (LCHS) has been open since the early 1950s. Early in the history of LCHS, nicknamed the Barons, a decision was made to compete in the Alberta Schools’ Athletic Association (ASAA) instead of the Saskatchewan High Schools Athletic Association (SHSAA). The city of Lloydminster is unique because it sits directly on the border of the provinces of Alberta and Saskatchewan. The student enrollment at LCHS fluctuates between 800 and 1,000 students each year. The reason for the fluctuation stems from three primary reasons. Many young families move into Lloydminster that have kids of different ages, which affects the school enrollments at various schools. The dependability of the oil and gas sector has seen great rises and dramatic setbacks in recent years. This has seen Lloydminster drop and swell in population numbers based on employment opportunities. Last, a third middle school to house students was opened in 2014. College Park School opened up as a kindergarten to Grade 9 school and has over 600 students in attendance. LCHS draws students from three schools in the public school division, but also has students who come from rural Saskatchewan and Alberta for the advanced placement programs in math and English, trades programming with technology advancements to prepare the students for the workforce, and over 140 course offerings. The writer of this paper hopes to show that a move to the SHSAA is necessary for the success of student athletes now and in the future. This essay highlights football, volleyball, and basketball as the primary sports of discussion. Subscribe to TPE

Gangrene of the intestines is a rare complication in pregnancy. Intestinal obstruction and ischemic bowel diseases are common causes of gangrene of the intestines in pregnancy. Adhesion bands can cause intestinal obstruction while arterial occlusion, venous thrombosis and vasculitis are some causes of ischemic bowel disease. We present a case of small intestinal gangrene in a 30 year old woman in her third pregnancy, diagnosed during emergency cesarean section with extensive gangrene of the ileum and jejunum caused by band formation at the illeo-caecal junction. This case, despite the unfortunate catastrophic outcome, highlights the subtle challenges of managing rare obstetric complication in resource limited settings.

La recherche en soins primaires connait une renaissance au Canada, stimulee par des preuves que le rendement eleve dans les systemes de sante repose sur eux,[2][1]. On s’interesse fortement aux effets des reformes des soins primaires, comme les changements aux modes de remuneration des m

Introduction: Liver fibrosis and cirrhosis are life-threatening conditions characterized by scarring of the liver tissue. They can result from various causes and lead to impaired liver function, severe complications, and increased mortality rates. This study aimed to analyze the mortality trends related to liver fibrosis and cirrhosis among different racial groups in the United States. Methods: In this study, we utilized the Wide-ranging Online Data for Epidemiologic Research (WONDER) database provided by the U.S. Centers for Disease Control and Prevention to identify patients who had died from liver fibrosis and cirrhosis, as determined by an International Classification of Diseases (ICD)-code version (K74.x) registered as the underlying cause of death. We then conducted a comparative analysis, examining and contrasting the mortality rates associated with liver fibrosis and cirrhosis between White and Black populations in the United States from 1999 to 2020. To ensure accurate comparisons, age-adjusted mortality rates were calculated per 1000,000 individuals (PMP), standardized using the US census data from 1999, and stratified based on race. Results: Between 1999 and 2020, our study identified a total of 353,887 deaths attributed to liver fibrosis and cirrhosis in 2 racial groups. This corresponded to an overall age-adjusted mortality rate of 50.3 per 1000,000 persons (PMP). Among these deaths, 321,779 occurred in individuals of White race, while 32,108 occurred in individuals of Black race. The age-adjusted mortality rate for liver fibrosis and cirrhosis was found to be 51.4 PMP in White individuals and 39.3 PMP in Black individuals. Notably, over the course of the 21-year period, we observed a significant decrease of 16% in the age-adjusted mortality rate among Black individuals, declining from 47.3 PMP in 1999 to 39.6 PMP in 2020. In contrast, there was an observed increase in age-adjusted mortality rates among White individuals, with a rise of 13% from 51.1 PMP in 1999 to 57.7 PMP in 2020. Conclusion: In summary, this study highlights significant variations in liver fibrosis and cirrhosis-related mortality rates among different racial groups in the United States between 1999 and 2020. The findings indicate that White individuals experienced the highest mortality rates, while African Americans exhibited the lowest rates. Significantly, the study also reveals a decline in liver fibrosis and cirrhosis-related mortality rates among Black individuals over the 21-year period, while rates increased among White individuals.