Recent publications
Background: Telestroke allows rapid assessment of patients presenting with acute stroke symptoms for intravenous thrombolysis or endovascular thrombectomy (EVT). Although the safety and efficacy of telestroke services for the delivery of intravenous thrombolysis has been well established, evidence on EVT decision-making is scarce.
Methods: We analysed data from OPTIMISE, a quality improvement registry to support EVT implementation in Canada. We assessed for unadjusted differences in baseline characteristics, time metrics, and procedural outcomes between patients transferred for EVT who received telestroke consultation and those who didn’t receive the service. We used mixed-effects logistic regression models to compare the likelihood for symptomatic intracerebral hemorrhage (SICH), good functional outcome (defined as a modified Ranking Scale score of 0-2), or all-cause mortality at 90 days between the two groups. All models were adjusted for predefined confounders and participating centre.
Results: Patients receiving telestroke consultation (n=997; 15%) had higher rates of carotid terminus occlusion (23.9% vs. 14.3%), but similar rates of M1-MCA and basilar occlusion compared to patients not receiving telestroke consultation (n=5,561). Patients receiving telestroke consultation had longer onset-to-door time (300.5 vs. 175 minutes) and onset-to-groin puncture time (344 vs. 233 minutes), but shorter door-to-groin puncture time (40 vs.70 minutes) compared to those not receiving telestroke consultation. No differences in groin puncture to reperfusion times, successful reperfusion rates, or adverse periprocedural events were found between the two groups. In the unadjusted analyses patients receiving telestroke consultation had higher rate of SICH (6.5% vs 3.1%), a lower rate for good functional outcome at 90-days (35.6% vs. 40.6%) and higher rate for all-cause mortality at 90 days (39.9% vs. 27.5%) compared to those not receiving telestroke consultation. Those differences were eliminated in the adjusted analyses.
Conclusion: Patients receiving telestroke consultation prior to EVT have prolonged treatment times and worse outcomes, compared to patients that did not receive telestroke consultation prior to EVT. The higher risk for unfavorable outcomes was eliminated after adjustment for confounders, including treatment time. There is a need for quality improvement initiatives to optimize the workflow of patients receiving telestroke consultation prior to EVT.
Background and Objectives: Transportation to comprehensive stroke centers (CSCs) from primary stroke centers (PSCs) is key to achieving fast reperfusion in endovascular treatment (EVT)-eligible patients. We aimed to evaluate outcomes and workflow times of patients treated PSCs vs CSCs and additional key metrics for those transported from PSCs to CSCs for EVT.
Methods: We performed a pre-specified analysis of the Alteplase compared to Tenecteplase (AcT) multicenter, randomized, controlled, trial in patients with acute ischemic stroke within 4.5 hours of onset. We compared baseline characteristics, workflow times, and clinical outcomes at 90 days between PSCs and CSCs. Mixed effects regression analyses were performed adjusting for age, sex, National Institute of Health Stroke Scale (NIHSS), location of intracranial occlusion, IVT drug and door-to-needle-time as fixed effects; and study site as a random effect.
Results: Of 1,577 patients enrolled in the trial, 99 (6.27%) were treated in PSCs while 1,478 (93.72%) were treated in CSCs. Patients in both groups had similar age (median 72 [64 - 82] vs 74 [63 - 83] years), proportion of females (42.42% vs 48.24%), baseline stroke severity (median NIHSS 9 [6 - 16] vs 10 [6 - 16.5]), presence of large vessel occlusion (24.24% vs 24.70%; p=0.919) and EVT utilization (24.24% vs 32.61%). Patients treated in PSCs had longer onset-to-needle (median, 139 [100 - 190] vs 128 [94 - 185] minutes) and door-to-needle times (median, 56.5 [42 - 70] vs 35 [27 - 47] minutes) compared to those treated at CSCs. For patients transferred from PSCs to CSCs, patients who received tenecteplase had shorter needle-to-puncture times than those who received alteplase (median, 35.5 [21 - 58] vs 52 [18 - 74] minutes, p<0.001). The proportion of patients achieving excellent functional outcome (mRS 0-1) at 90 days was higher at PSCs compared to CSCs (48.48% vs 35.01%, adjusted IRR, 1.42 [CI 95%, 1.04 - 1.95]).
Conclusions: Despite less efficient workflows for IVT administration and similarities in baseline characteristics, the proportion of patients receiving initial treatment in PSCs who had excellent functional outcomes was higher compared to CSCs. Among those who received tenecteplase prior to CSC transfer, more efficient time metrics were noted.
Background and Objectives: Emerging literature suggests that non-stenotic carotid disease (<50% stenosis), especially in the presence of high-risk plaque features, can be a possible etiology for ischemic stroke. We aimed to evaluate the odds of concordant stroke among individuals with non-stenotic carotid arteries with various plaque features.
Methods: This is a secondary analysis from the Alteplase compared to Tenecteplase (AcT) trial. We evaluated carotid arteries on baseline CT Angiogram (CTA) to assess the degree of stenosis, plaque features such as ulceration, thickness, irregularity, hypodensity and presence of intraluminal thrombi, carotid web and dissection. 24hour follow-up imaging was used to evaluate stroke location. At a carotid level, we performed mixed effects logistic regression analysis adjusted for age and sex, with patient ID as a random effects variable, to determine the association between each high-risk plaque feature and the presence of concordant stroke (ipsilateral acute stroke in the territory of the carotid artery).
Results: Of 1577 patients in the trial, 1407 (89.2%) had interpretable baseline imaging.
Of these, 329 (23.4%) had no carotid disease, 869 (61.8%) had non-stenotic (<50%) carotid disease and 209 (14.9%) had stenotic (>50%) carotid disease. At a carotid level,
2519 (89.5%) had non-stenotic carotid disease. Of these, 689 (27.4%) had concordant stroke. Intraluminal thrombi and carotid webs were significantly associated with concordant stroke (aOR 8.11, 95% CI 1.6 – 41.08 and aOR 3.58, 95% CI 1.53 – 8.35, respectively). None of the other plaque features were significantly associated with concordant stroke.
Conclusions: Among patients with non-stenotic carotid disease, only the presence of intraluminal thrombi and carotid webs were found to be associated with increased odds of concordant stroke. Further CTA-based studies on larger populations are required to identify plaque features associated with concordant ischemic stroke.
Background
Mitral valve repair (MVr) is the gold standard treatment for degenerative mitral regurgitation, yet there is ongoing controversy regarding optimal anti-thrombotic therapy post-MVr. This scoping review aimed to summarise current evidence on the safety and efficacy of anti-thrombotic therapy after MVr, identify knowledge gaps and propose a future study design.
Methods
We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, the WHO International Clinical Trials Registry Platform and bibliographies of included trials, guidelines and other reviews from inception to 17 September 2024. Randomised controlled trials (RCT) and cohort and case-control studies assessing any anti-thrombotic therapy with any outcomes after MVr were included. Using a predefined collection form, two authors independently extracted data on study characteristics and results were summarised narratively into themes based on the PICO elements.
Results
Of 1296 screened references, we included 11 studies (10 cohort and one non-inferiority RCT). All studies compared vitamin K antagonist (VKA) to an anti-platelet, direct oral anti-coagulant or no anti-thrombotic therapy for median duration of 90 days. Thromboembolic and bleeding event incidences ranged from 0% to 14.3% and 0% to 9.1%, respectively. Seven studies reported no difference in thromboembolic events, and three reported reduced rates with VKA compared with control, while results for bleeding events varied widely. The RCT found edoxaban was non-inferior to warfarin for thromboembolic outcomes, but not for bleeding. Substantial methodological and clinical heterogeneity, high risk of bias and insufficient mitigation of confounders, such as concomitant atrial fibrillation, were prevalent across studies.
Conclusion
Based on this scoping review, existing literature on anti-thrombotic therapy after MVr is inconclusive due to design limitations. We proposed a study design for a pragmatic RCT that addresses prior study limitations and that could provide definitive evidence to guide anti-thrombotic management in MVr patients.
Background
Classic teaching is that spinal anesthesia is safe at or below the L2–L3 interspace. To evaluate this, we sought to determine the percentage of individuals with a conus medullaris termination (CMT) level at or below the L1–L2 interspace. Further, the relationship of CMT level to age, sex, body mass index (BMI), and spinal pathology was examined, as was the reliability of using Tuffier's line (TL) as an anatomical landmark.
Methods
This retrospective study evaluated magnetic resonance images of 944 adult patients to determine the CMT level. The relationship between age, sex, height, BMI, and spinal pathology and CMT level was explored by logistic regression. The correspondence of the TL line to the L4–L5 interspace and the presence of overlap with the CMT were examined using 720 lumbar x‐rays of the same patient cohort.
Results
Of 944 patients (mean age, 57.8 years; 49% male), 18.9% had CMT at or below the L1–L2 interspace, and spinal anesthesia at the L2–L3 interspace was found to carry a 0.7% incidence of neuraxial risk. Only the presence of congenital spinal abnormalities was found to be significantly predictive of having a CMT at or below the L1–L2 interspace. TL was found to correspond to the L4–L5 interspace in 99.8% of patients with lumbar x‐rays.
Conclusions
Spinal anesthesia at the L2–L3 interspace, using TL as an anatomical landmark, is safe in >99% of patients. However, caution must be exercised in all patients as demographic variables were found to be limited in predicting a low CMT level.
Editorial Comment
Unlike previous smaller studies, this retrospective study included MRI data from a total of 944 patients. The present study confirms that spinal anesthesia at the L2–L3 interspace or below can be considered safe. The findings indicate that Tuffier's line can be used as a reliable anatomical landmark.
Aims
We measured the association between prescribed stimulant medications and overdose among individuals receiving opioid agonist therapy (OAT) for opioid use disorder.
Design
Retrospective cohort study using the British Columbia Provincial Overdose Cohort, a linked administrative database.
Setting
We used data from British Columbia, Canada, from January 2015 through February 2020.
Participants
In total, 9395 individuals contributed 18 273 person‐years of follow‐up while dispensed OAT.
Measurements
We examined the association between stimulant prescription (primary exposure) and fatal or non‐fatal overdose (primary outcome, allowing for recurrent events) after adjusting for potential confounders including sociodemographic characteristics and substance use patterns. As a secondary analysis, we evaluated type of OAT (full agonists involving methadone or slow‐release oral morphine versus partial agonist involving buprenorphine/naloxone alone) as a potential effect modifier.
Findings
There were 1746 overdose events; 37 (2.1%) were fatal. Overall, there was no increased risk of overdose among individuals dispensed a stimulant medication while on OAT [adjusted Cox regression hazard ratio (AHR) = 1.13, 95% confidence interval (95% CI) = 0.86–1.49, P = 0.39]. When analyzed by type of OAT medication, for individuals on buprenorphine, dispensation of a stimulant medication was associated with a reduced risk of overdose (AHR = 0.47, 95% CI = 0.23–0.96, P = 0.037) while, for individuals on full agonist OAT, dispensation of a stimulant medication was associated with an increased risk of overdose (AHR = 1.51, 95% CI = 1.09–2.07, P = 0.012).
Conclusions
There does not appear to be an overall increased risk of overdose for individuals co‐prescribed a stimulant medication with opioid agonist therapy (OAT). There appears to be a reduced risk of overdose for individuals dispensed buprenorphine with a stimulant medication compared with those dispensed buprenorphine alone, and an increased risk of overdose for individuals dispensed full agonist OAT (methadone or slow‐release oral morphine) with a stimulant medication compared with those dispensed full agonist OAT alone.
Three Cannings brothers describe their intertwined but separate careers in Canadian biology: Rob as an entomologist, Syd as an entomologist and conservation biologist, and Dick as an ornithologist and politician. They emphasise the influence on their lives of the British Columbia’s Okanagan Valley where they grew up, the naturalist family in which they were raised, and the mentors who inspired them in their work. Bird study and nature interpretation in BC Parks were early enthusiasms and influences. Biological research, museum work, nature conservation, public education, and writing have dominated their careers. In Dick’s case, his public life has culminated in a decade of Canadian federal politics as a member of Parliament.
This article is modified from the closing plenary address presented at Entomology 2022, the joint annual meeting of the Entomological Society of America, the Entomological Society of Canada, and the Entomological Society of British Columbia, in Vancouver, British Columbia, Canada, 16 November 2022. The presentation also acted as the 2022 Heritage Lecture of the Entomological Society of Canada.
Most diffuse large B-cell lymphoma (DLBCL) patients treated with immunotherapies such as bispecific antibodies (BsAb) or chimeric antigen receptor (CAR) T cells fail to achieve durable treatment responses, underscoring the need for a deeper understanding of mechanisms that regulate the immune environment and response to treatment. Here, an integrative, multi-omic approach was applied to multiple large independent datasets in order to characterize DLBCL immune environments, and to define their association with tumor cell-intrinsic genomic alterations and outcomes to CD19-directed CAR T-cell and CD20 x CD3 BsAb therapies. This approach effectively segregated DLBCLs into four immune quadrants (IQ) defined by cell-of-origin and immune-related gene set expression scores. These quadrants consisted of activated B cell-like (ABC) hot, ABC cold, germinal center B cell-like (GCB) hot, GCB cold DLBCLs. Recurrent genomic alterations were enriched in each IQ, suggesting that lymphoma cell-intrinsic alterations contribute significantly to orchestrating unique DLBCL immune environments. For instance, SOCS1 loss-of-function mutations were significantly enriched among GCB hot DLBCLs, identifying a putative subset of inflamed DLBCLs that may be inherently susceptible to immunotherapy. In relapsed/refractory DLBCL patients, DLBCL-IQ assignment correlated significantly with clinical benefit with a CD20 x CD3 BsAb (n = 74), but not with CD19-directed CAR T cells (Stanford, n = 51; MSKCC, n = 69). Thus, DLBCL-IQ provides a new framework to conceptualize the DLBCL immune landscape and suggests the endogenous immune environment has a more significant impact on outcomes to BsAb compared to CAR T cell treatment.
Introduction/Aims
Upper limb paralysis is arguably the most limiting consequence of cervical spinal cord injury (cSCI). There is limited knowledge regarding the early structural changes of muscles implicated in grasp/pinch function and upper extremity nerve transfer surgeries. We evaluated: (1) muscle size and echo intensity (EI) in subacute cSCI (2–6 months) and (2) the influence of lower motor neuron (LMN) damage on these ultrasound parameters.
Methods
Cross‐sectional B‐mode images were captured bilaterally in individuals with cSCI (injury duration: 3.3 ± 1.2 months; C4–C6 injury levels; American Spinal Injuries Association Impairment Scale A–C; 45.7 ± 13.7 years; 3 females, 14 males) for biceps brachii (BB), extensor carpi ulnaris, extensor indicis proprius, flexor pollicis longus (FPL), and first dorsal interosseous. Each limb was analyzed as an independent event ( n = 34). Cross‐sectional area (CSA), thickness (MT), and EI were compared to healthy controls (HC). BB and FPL concentric needle electromyography (EMG) data were also obtained. Abnormal LMN health was defined by the presence of pathological spontaneous activity.
Results
Relative to HC, forearm and hand muscle size were 15%–41% lower ( p < 0.05), while EI was 21%–40% higher ( p < 0.05); no significant differences were observed for sublesional BB muscles ( n = 16) ( p > 0.05). Muscles demonstrating abnormal LMN health displayed reduced BB MT and elevated FPL EI ( p < 0.05).
Discussion
These results underscore the substantial changes in forearm and hand muscle morphology within the subacute period after cSCI, with preliminary evidence suggesting that these changes are influenced by LMN damage.
Purpose
Understanding real-world treatment patterns and their effectiveness in HR + HER2- advanced breast cancer (aBC) in Canadian patients.
Patient and Methods
This was a multi-center, observational, prospective cohort study including men and pre-/peri-/postmenopausal women with HR + HER2- aBC receiving endocrine therapy (ET) or ET + targeted therapy (ET + TT). The primary objective was duration of treatment (DOT) with ET and ET + TT. Sequence of therapies, treatment patterns, and Overall Survival (OS) were also evaluated.
Results
DOT was prolonged in patients receiving ET + TT compared to ET (median DOT: ET + TT 397 days vs ET 192 days; Log-Rank test p value < .0001; HR = 0.66; 95% CI; 0.52, 0.85). An extended DOT was observed in ET + CDK4/6i subgroup when compared to ET (median DOT: ET + CDK4/6i 601 days vs ET 192 days; Log-Rank test p value < .0001). This increase was statistically significant irrespective of line of therapy at baseline (1L: median DOT: ET + CDK4/6i: 649 days vs ET: 217 days, p value = < .0001; 2L: median DOT: ET + CDK4/6i: 487 days vs ET: 203 days, p value = 0.0013; 3L: median DOT: ET + CDK4/6i: 597 days vs ET: 143 days therapy: p value = 0.0006). ET alone and ET + CDK4/6i were the most frequently administered therapies in both 1st (ET alone: 43.5% and ET + CDK4/6i: 43.3%) and 2nd lines (ET alone: 36.3% and ET + CDK4/6i: 24.6%). Among patients who received at least one CDK4/6i in 1st, 2nd, or 3rd line, CDK4/6i were mostly administered in 1st line (61.9%) and 2nd line (38.5%). ClinicalTrials.gov ID: NCT02753686; Registration Date:20–04-2016.
Conclusion
Results support current treatment recommendations of early introduction of CDK4/6i in HR + /HER2- aBC.
Background
Inconsistencies in the workup of labral tears in the hip have been shown to result in a delay in treatment and an increased cost to the medical system.
Purpose
To establish consensus statements among Canadian nonoperative/operative sports medicine physicians via a modified Delphi process on the diagnosis, nonoperative and operative management, and rehabilitation and return to play (RTP) of those with labral tears in the hip.
Study Design
A consensus statement.
Methods
A total of 40 sports medicine physicians (50% orthopaedic surgeons) were selected for participation based on their level of expertise in the field. Experts were assigned to 1 of 4 balanced working groups defined by specific subtopics of interest. Consensus, strong consensus, and unanimous consensus were defined as achieving 80% to 89%, 90% to 99%, and 100% agreement with a proposed statement, respectively.
Results
There was a unanimous consensus that several prognostic factors—including age, pain severity, dysplasia, and degenerative changes—should be taken into consideration with regard to the likelihood of surgical success. There was strong agreement that the cluster of symptoms of anterior groin pain, pain in hyperflexion, and sharp catching pain with rotation make a diagnosis of a labral tear more likely, that radiographs—including a minimum of a standing anteroposterior pelvis and 45° Dunn view—should be obtained in all patients presenting with a suspected labral tear, that a diagnostic injection should be performed if there is uncertainty that the pain is intra-articular in origin, and that a minimum of 6 months should elapse after surgical treatment before reinvestigation for persistent symptoms.
Conclusion
Overall, 76% of statements reached a unanimous/strong consensus, thus indicating a high level of agreement between nonoperative sports medicine physicians and orthopaedic surgeons on the management of labral tears in the hip. The statements that achieved unanimous consensus included the timing of RTP after surgery, prognostic factors affecting surgical success, and the timing to begin sport-specific training after nonoperative management. There was no consensus on the use of orthobiologics for nonoperative management, indications for bilateral surgery, whether the postoperative range of motion and weightbearing restrictions should be employed, and whether postoperative hip brace usage is required.
Objectives
Describe patterns of pharmacotherapy and psychological treatment and evaluate receipt of minimally adequate treatment for incident depression and anxiety in individuals with inflammatory arthritis (IA).
Methods
We used population-based linked administrative health databases from British Columbia, Canada to evaluate pharmacotherapy and psychological treatments for incident depression and/or anxiety among individuals with IA and without IA (‘IA-free controls’). We defined minimally adequate pharmacotherapy as antidepressant prescriptions filled with ≥ 84 days’ supply and adequate psychological treatment as ≥ 4 counselling/psychotherapy services. Multivariable logistic regression models were used to evaluate the odds of individuals with IA receiving minimally adequate pharmacotherapy and/or psychological treatment compared to IA-free controls.
Results
6,951 (mean age 54.8 ± 18.3 years; 65.5% female) individuals with IA had incident depression and 3,701 (mean age 52.9 ± 16.8 years; 74.3% female) had incident anxiety. Minimally adequate pharmacotherapy and psychological treatment for depression was respectively observed in 50.5% and 19.6% of those with IA, proportions similar to IA-free controls (pharmacotherapy: aOR 1.10, 95% CI 1.00 to 1.21; psychological: aOR 1.07, 95% CI 0.94 to 1.21). Results were similar regarding anxiety treatment. Individuals with IA had a significantly greater likelihood of dispensing ≥ 1 benzodiazepine (anxiety: IA 45.0%, IA-free controls 39.0%, p-value < 0.001) and ≥ 1 tricyclic antidepressant prescription (anxiety: IA 12.8%, IA-free controls 7.8%, p-value < 0.001). Significantly higher average days’ supply of benzodiazepines was observed for IA (anxiety: IA 123.7 days, controls 112.4 days, p-value = 0.003).
Conclusions
A substantial proportion of individuals with IA were not receiving adequate mental health treatment for depression and anxiety, a finding similar for IA-free controls. The undertreatment of mental disorders for people with IA has well-known negative implications for the provision of effective rheumatology care. It remains fundamental to expand publicly funded health care to include mental health services in an effort to address unmet counselling needs.
Background
Hyperthyroid cats that are azotemic and hypothyroid after surgical or medical treatment have poor outcomes, and supplementation with levothyroxine (LT4) improves survival. However, the effect of LT4 supplementation on survival of nonazotemic, hypothyroid radioiodine (RI)‐treated hyperthyroid cats is unknown.
Hypothesis
Radioiodine treated hyperthyroid cats with iatrogenic hypothyroidism or azotemia have shorter survival times than euthyroid, nonazotemic cats and supplementation of LT4 improves survival times of hypothyroid cats.
Animals
One hundred seventeen RI treated hyperthyroid cats.
Methods
Prospective cohort study. Radioiodine treated cats were screened for azotemia and iatrogenic hypothyroidism using TSH stimulation test; LT4 supplementation was offered to all hypothyroid cats with decision to treat based on owner preference. The log rank test was used to compare survival times between groups, and the Mann‐Whitney U test was used to compare age and renal variables. Data are presented as median [range].
Results
Euthyroid azotemic cats (934 [759‐2035] days) and nonsupplemented hypothyroid cats (azotemic and nonazotemic combined, 1232 [238‐2363] days) had shorter survival times than euthyroid nonazotemic cats (1616 [663‐3369] days, P = .003 and P = .002, respectively). Levothyroxine supplemented hypothyroid nonazotemic cats had longer survival times than nonsupplemented hypothyroid nonazotemic cats (1037 [300‐2401] days vs 768 [34‐1014] days; P = .027). Levothyroxine supplementation was not associated with prolonged survival times in hypothyroid azotemic cats vs nonsupplemented hypothyroid azotemic cats (771 [718‐1558] days vs 152 [82‐1852] days, respectively, P = .991).
Conclusions and Clinical Importance
Levothyroxine supplementation in nonazotemic cats with iatrogenic hypothyroidism (diagnosed based on TSH stimulation test results) improved survival times, although randomized controlled trials are needed.
Objective
Despite knowledge that health outcomes vary according to patient characteristics, identity, and geography, including underrepresented populations in arthritis research remains a challenge. We conducted interviews to explore how researchers in arthritis have used equity, diversity, and inclusion (EDI) principles to inform their research.
Methods
Semistructured interviews were conducted with individuals who 1) have experience conducting arthritis research studies, 2) reside in and/or conduct their research in Canada, and 3) speak English or French. Participants were recruited using purposive and respondent‐driven sampling. Interviews were conducted over video call and audio recordings were transcribed. Template analysis was applied to interview transcripts to explore participant experiences and perceptions of EDI in arthritis research.
Results
Participants (n = 22) identified that a lack of representation in arthritis research translates to the inability to provide comprehensive care. Participants emphasized considering EDI early in all arthritis research to effectively affect a study. Themes were categorized as benefits, barriers, and facilitators. The perceived benefits were the ability to generate knowledge and reduce health disparities. Barriers included mistrust from historically exploited populations, unintended consequences, lack of access to research opportunities, and logistical challenges. Facilitators included building community partnerships, curating diverse research teams, incentivizing researchers and funder support, and fostering humility in research environments.
Conclusion
Improving representation in research is needed to improve health outcomes for diverse groups of people living with arthritis. Identified barriers to EDI in research must be addressed and partnerships and supports must be facilitated to achieve more representation in arthritis research within Canada.
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Background
Healthcare resources have been concentrated in urban areas, leaving rural regions vulnerable to poorer health outcomes. The Problem Solving for Better Health (PSBH) program was implemented to enhance healthcare systems in resource-limited regions by training personnel to maximize existing resources in problem-solving. This study evaluated the implementation effectiveness of PSBH-Nursing (PSBHN), a nationally led initiative to train nurses in PSBH in Lesotho.
Methods
A mixed-methods study employing a single-group pre-test post-test design was conducted, guided by the RE-AIM theory. Training occurred from November 2021 to June 2022. Nurses completed the Problem-Solving Inventory (PSI) before and 3–6 months after training to measure changes in problem-solving efficacy. Quality scores were assigned to nurses’ planned quality improvement projects; project implementation was assessed 3–6 months after training. In-depth interviews (IDIs) explored changes in knowledge, problem-solving efficacy, and skills. Statistical analyses utilized paired T-tests and logistic regressions using STATA 17; content analysis was conducted on IDIs using NVivo12.
Results
Of 300 nurses, 89 were trained (30%) in the first year. Mainly medium or high-quality scores were achieved for the project designed. However, among 79 participants, only 49.4% reported initiating their projects. Overall problem-solving efficacy improved 3–6 months after training, but the increase was not statistically significant. Nurses reported improved knowledge, confidence and communication skills, enhanced problem-solving approaches, and increased emotional maturity in solving problems. A one-unit increase in project quality score correlated with a 35.0% increase in the odds of project initiation.
Conclusion
PSBHN demonstrated improved knowledge and minimal improvement in problem-solving efficacy among nurses 3–6 months post-training. However, application of skills gained in implementing their projects was insufficient. Still, PSBHN shows promise in addressing healthcare challenges in resource-limited settings. Some participants were able to start their projects but the inconsistency in follow-through suggests a need for more research into the factors that can improve completion of implementation for better health outcomes.
Introduction
The pharmacological management of inflammatory arthritis often requires choices that involve trade-offs between benefits, risks and other attributes such as administration route, frequency and cost. This living systematic review aims to inform international clinical guidelines on inflammatory arthritis by creating an evidence map of patient preference studies concerning the trade-offs in pharmacological management of inflammatory arthritis.
Methods and analysis
We will include published and peer-reviewed full-text studies in any language that quantitatively assess preferences of patients for the pharmacological management of inflammatory arthritis (rheumatoid arthritis, spondyloarthritis and juvenile idiopathic arthritis). Studies must use either stated or revealed preference methods to assess preferences and provide a quantitative assessment of relevant characteristics, such as benefits, risks, costs and process attributes. Articles will identified through Medline and EMBASE database searches from inception using search terms that combine keywords and subject headings for inflammatory arthritis and preference-based methods, and a search in the Health Preference Study and Technology Registry using keywords for the populations of interest. Two independent reviewers will perform abstract and full-text screening. Risk of bias will be assessed using the GRADE risk of bias tool. An evidence map will be generated to summarise included studies and their assessments of each trade-off. The search will be conducted every 6 months with new studies added to the inventory.
Ethics and dissemination
Ethics approval is not required. Results from the base review will be published in a peer-reviewed journal and findings will be presented at conferences. In the living model, we will publish updates and datasets on an Open Science Framework page, with periodic updates in peer-reviewed journals.
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