Foothills Medical Centre Research Articles

Outcomes of Endoscopic Endonasal Surgery for Tuberculum Sellae and Planum Sphenoidale Meningiomas: A Retrospective Study.

To evaluate clinical outcomes and volumetric changes following endoscopic endonasal approach (EEA) for tuberculum sellae (TS) and planum sphenoidale (PS) meningiomas. Key objectives included evaluating pre- and postoperative tumor volumes, visual assessments and EEA-related complications. A single-center retrospective study was conducted at Foothills Medical Centre, University of Calgary, Canada, from 2009 to 2022 including 24 patients meeting inclusion criteria for midline skull base tumors, confirmed as WHO Grade I or II meningiomas with optic canal extension. EEA achieved gross total resection in 87.5% of cases, with a mean tumor volume reduction of 92.24%. Postoperatively, 91.67% exhibited visual improvement or stability. Cerebrospinal fluid leaks occurred in 12.5% of cases, necessitating revision surgery in one case. Persistent postoperative endocrine dysfunction affected 4.17%. Preoperative tumor volume did not demonstrate a correlation with complications. This study delivers reproducible data for pre- and postoperative tumor volume following the EEA after TS or PS meningiomas. The EEA demonstrated favorable radiographic and clinical outcomes in TS and PS meningiomas, achieving gross total resection with minimal morbidity.

Co-localization of NCCT hypodensity and CTA spot sign predicts substantial intracerebral hematoma expansion: The Black-&-White sign.

Existing radiological markers of hematoma expansion (HE) show modest predictive accuracy. We aim to investigate a novel radiological marker that co-localizes findings from non-contrast CT (NCCT) and CT angiography (CTA) to predict HE. Consecutive acute intracerebral hemorrhage patients admitted at Foothills Medical Centre in Calgary, Canada, were included. The Black-&-White sign was defined as any visually identified spot sign on CTA co-localized with a hypodensity sign on the corresponding NCCT. The primary outcome was hematoma expansion (⩾6 mL or ⩾33%). Secondary outcomes included absolute (<3, 3-6, 6-12, ⩾12 mL) and relative (0%, <25%, 25%-50%, 50%-75%, or >75%) hematoma growth scales. Two-hundred patients were included, with 50 (25%) experiencing HE. Forty-four (22%) showed the spot sign, 69 (34.5%) the hypodensity sign, and 14 (7%) co-localized both as the Black-&-White sign. Those with the Black-&-White sign had higher proportions of HE (100% vs 19.4%, p < 0.001), greater absolute hematoma growth (23.37 mL (IQR = 15.41-30.27) vs 0 mL (IQR = 0-2.39), p < 0.001) and relative hematoma growth (120% (IQR = 49-192) vs 0% (0-15%), p < 0.001). The Black-&-White sign had a specificity of 100% (95%CI = 97.6%-100%), a positive predictive value of 100% (95%CI = 76.8%-100%), and an overall accuracy of 82% (95%CI = 76%-87.1%). Among the 14 patients with the Black-&-White sign, 13 showed an absolute hematoma growth ⩾12 mL, and 10 experienced a HE exceeding 75% of the initial volume. The inter-rater agreement was excellent (kappa coefficient = 0.84). The Black-&-White sign is a robust predictor of hematoma expansion occurrence and severity, yet further validation is needed to confirm these compelling findings.

Assessing the impact of aprepitant on response to dose-intensive cyclophosphamide, etoposide, and cisplatin (DICEP).

Despite evidence demonstrating the effectiveness of aprepitant for chemotherapy-induced nausea and vomiting (CINV), its use in stem cell transplant settings across Canada is not standard. While pharmacokinetic data exists, the clinical significance of cytochrome P450 3A4 (CYP 3A4) inhibition of cyclophosphamide by aprepitant is unclear. Reduced activation of cyclophosphamide may reduce the effectiveness of dose-intensive cyclophosphamide, etoposide, and cisplatin (DICEP). To compare response rates to DICEP in patients with Hodgkin lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL) in the presence and absence of aprepitant. A retrospective review of patients who received full-dose DICEP for relapsed/refractory HL or DLBCL between June 1995 and September 2018 at the Foothills Medical Centre (FMC) in Calgary, Alberta, Canada was conducted. Descriptive statistics were used to assess response rate, as defined by the 2007 International Working Group response criteria. Of the 218 patients included in this study, 87.6% of patients in the control group and 88.5% of patients in the aprepitant group responded to DICEP (difference 0.025 [95% CI, -0.066 to 0.114], p = 0.827). Univariate analyses for age, sex, type of cancer, stage of cancer, number of prior relapses, and relapse status were not significant. No significant differences were observed for secondary outcomes. Response rates to DICEP in relapsed/refractory HL and DLBCL patients were similar regardless of aprepitant use. Considering these results and the effectiveness of aprepitant in CINV, its addition to standard antiemetic therapy in patients receiving DICEP should be given strong consideration in the transplant setting.

The association between body mass index and molecular subtypes in endometrial carcinoma

ObjectiveThis study aims to investigate the relationship between body mass index (BMI) and molecular subtypes of endometrial carcinoma using an immunohistochemistry (IHC)-based classification approach. MethodsWe analyzed a consecutive series of endometrial cancer cases undergoing surgical staging in southern Alberta (2019–2021). Molecular classification was determined through IHC-based molecular typing, incorporating p53 and mismatch repair (MMR), and further characterized with the addition of ER and PR. BMI associations with molecular classification were assessed using t-tests. Hormone receptor status was further examined in a separate cohort of MMRd endometrial cancer patients undergoing surgical staging at Foothills Medical Centre (Alberta, Canada). ResultsAmong 289 cases, comprising various histological subtypes, the pNSMP subtype exhibited the highest average BMI (33.93 kg/m2) compared to the p53 abnormal subtype (30.40 kg/m2, p = 0.02). The MMRd subtype had an average BMI of 33.22 kg/m2. While there were no significant BMI differences between FIGO grade 1 and grade 2/3 tumours in the pNSMP or MMRd, a trend toward higher BMI in grade 1 tumours versus grade 2/3 tumours in the MMRd was observed (p = 0.13). A separate cohort of 53 MMRd endometrial carcinomas revealed that FIGO grade 1 tumours were associated with higher BMI (p < 0.05) and more frequent ER/PR expression compared to grade 2/3 tumours (p < 0.05). ConclusionsThis study suggests an association between obesity and NSMP endometrial carcinoma. The relationship between BMI and low-grade MMRd endometrial carcinomas with increased ER/PR expression warrants further exploration.

2453. Wastewater-Based Surveillance of Vancomycin-Resistant Enterococci in Hospitals

Abstract Background Vancomycin-resistant Enterococcus (VRE) is an important nosocomial infection that may increase patient morbidity, mortality, and healthcare costs. We have adapted wastewater-based surveillance (WBS) as a novel tool to comprehensively and inclusively monitor the burden of VRE in tertiary acute care hospitals. Herein, we demonstrate our ability to detect, quantify and track VRE dynamically over time across a range of scales. Methods Wastewater (WW) was collected from three hospitals in Calgary, AB: Rockyview General Hospital (RGH; 615 beds), Peter Lougheed Centre (PLC; 517 beds), and Foothills Medical Centre (FMC via three independent sites – A, B, C; 1100 beds). Three WW treatment plants (WWTPs; BBW, PCW, and FCW) serving the entire City of Calgary were sampled as community controls. DNA was extracted from WW pellets obtained following centrifugation. A multiplexed qPCR assay was adapted and used to quantify the abundances of the vanA and vanB resistance gene copies. Copy numbers were assessed as raw (copies per mL of WW processed) or normalized against three fecal biomarker genes: total bacterial 16S rRNA, human 18S rRNA, and Bacteroides HF183 16S rRNA. Differences between hospitals and controls were determined with Mann-Whitney tests (GraphPad Prism version 9.0). Results Samples from the hospitals and WWTPs in Calgary, AB collected over 12 weeks demonstrated that all hospitals had 100-1000X higher mean aggregate abundances of both vanA and vanB relative to community-based WWTPs when assessed as raw or normalized by each fecal biomarker (Figure 1; only total bacterial 16S rRNA is shown, p&amp;lt; 0.001, Mann-Whitney). Within one individual hospital (RGH), each of vanA and vanB abundances follows similar trends over a 12-week period, regardless of whether the values were reported as raw or normalized with the three different fecal biomarker genes (Figure 2; only vanA is shown).Figure 1.Mean aggregate copy numbers of vanA and vanB in wastewater measured by qPCR. VRE vanA and vanB gene abundances normalized as a ratio against total bacterial 16S rRNA copies demonstrate significantly higher abundances of both vanA and vanB in hospitals than the WWTP community controls.Figure 2.Comparison of vanA gene copies assessed as raw versus normalized as measured by qPCR from Rockyview General Hospital (RGH). VRE vanA gene abundances in Rockyview General Hospital (RGH) WW assessed as raw and normalized as a ratio against three different fecal biomarkers (total bacterial 16S rRNA, human 18S rRNA and Bacteroides HF183 16S rRNA) demonstrated similar trends in vanA gene abundances over time. Conclusion WBS is a unique real-time tool that can be adapted to monitor the abundance of VRE across a range of scales. This tool has the potential to augment antimicrobial stewardship and infection prevention and control programs to better understand the contributing factors to selection and colonization. Disclosures All Authors: No reported disclosures

Interprofessional Teamwork: A Qualitative Study on Adapting Central Policies to Local Conditions in a Labour and Delivery Unit

ObjectivesWe record the experiences of staff in a labour, delivery, and obstetric services (LD-OBS) unit in Alberta’s largest quaternary medical centre—the Foothills Medical Centre (FMC)—as they navigated hospital policies during the COVID-19 pandemic. We examine how unit leadership applied these policies to better align with care delivery realities while staying true to the interprofessional nature of the unit. MethodsA total of 12 semi-structured qualitative interviews were conducted with LD-OBS unit staff. Snowball and purposive sampling strategies were used to capture experiences from key informants. Interview transcripts underwent inductive coding. The themes identified through this process were discussed with members of the authorial team until a consensus was reached. ResultsFMC LD-OBS team members used ‘interprofessional’ as a value through which to interpret, adapt, and implement centrally developed COVID-19 policies. These were applied at 3 key moments: reconfiguring the unit, triaging, and rerouting patients, and contesting central personal protective equipment policies. LD-OBS leaders championed the importance of interprofessional collaboration and teamwork in the unit and worked to uphold it as a practice and value. ConclusionThe COVID-19 pandemic experience of the FMC LD-OBS unit illustrates the importance of considering interprofessionalism as a core value as policy was developed and implemented. Health authorities, hospitals, and other LD-OBS units may wish to consider how interprofessional work affects policy interpretation among health care teams, and how this may be leveraged to successfully adapt policies to local units, under both pandemic and ‘normal’ conditions.

Natural history of antiplatelet nonresponders undergoing carotid artery stenting.

Routine antiplatelet responsiveness testing for patients undergoing carotid artery stenting procedures is not performed at most endovascular centers and remains a topic of controversy within the neurointerventional community. The objective of this study was to determine if nonresponsiveness to acetylsalicylic acid or clopidogrel was associated with the development of symptomatic thromboembolic events in patients undergoing carotid stenting procedures. A prospective study was conducted at the Foothills Medical Centre in Calgary, Alberta, Canada, from August 2019 to July 2021. Patients undergoing carotid artery stenting procedures and who were receiving dual antiplatelet therapy were enrolled in the study. Responsiveness to the antiplatelet medications was determined through whole blood impedance aggregometry. The primary outcome was development of a symptomatic thromboembolic event within 90 days after the procedure. The treating physicians were blinded to the aggregometry results for the duration of the study. One hundred two procedures were performed in 100 patients. Eight thromboembolic events (8%) occurred during the study. Age (p = 0.03) and nonresponsiveness to clopidogrel (p = 0.003) were associated with the development of thromboembolic events. The multivariable model showed that clopidogrel nonresponsiveness was independently associated with the development of a thromboembolic event (adjusted OR 6.14, 95% CI 1.25-30.11, p = 0.03). This study demonstrated that patients who were identified as clopidogrel nonresponders, using whole blood impedance aggregometry, were at an increased risk of developing thromboembolic events. Larger studies are needed to assess the utility of routine platelet function testing prior to carotid artery stenting procedures.

Preoperative Hypoalbuminemia Is Associated with Increased Mortality in Patients Undergoing Surgery for Gynaecologic Malignancy – A Retrospective Cohort Study

ObjectiveOur objective was to evaluate the significance of reduced preoperative albumin levels on short-term (90-day and 1-year) mortality in patients undergoing surgery for gynaecologic malignancy in Calgary, Alberta, Canada. MethodsIn this retrospective cohort study, patients with gynaecologic malignancies who had surgery performed at Foothills Medical Centre in Calgary, Alberta, Canada between January 1, 2010, and June 30, 2016, were identified. We performed univariable and multivariable logistic regression analyses to evaluate the association between preoperative serum albumin and 90-day and 1-year mortality. Analysis was conducted with albumin initially as a continuous variable, and subsequently as a categorical variable after clinically relevant threshold levels were identified. ResultsA total of 2183 patients were included in our analysis. Of the study population, 51.8% had a preoperative serum albumin level of <35 g/L. Two critical inflection points in mortality rate by serum albumin level were found. Mortality was significantly highest in patients with an albumin level <20 g/L (90-day mortality 17.2%, 1-year mortality 31.9%) and next highest in patients with an albumin level of 20–25 g/L (90-day mortality 2.7%, 1-year mortality 12.0%), compared to patients with a level of >25 g/L (90-day mortality 0.9%, 1-year mortality 3.9%). In both univariable and multivariable analyses, preoperative hypoalbuminemia was significantly and independently associated with increased 90-day and 1-year mortality (P < 0.001). ConclusionPreoperative hypoalbuminemia is independently associated with increased mortality. Patients with gynaecologic malignancies undergoing surgery and who have a preoperative serum albumin level of <20 g/L are at a very high risk of short-term mortality.

A77 THE ASSOCIATIONS OF OBJECTIVELY ASSESSED SEDENTARY TIME AND STEP COUNT ON ULCERATIVE COLITIS OUTCOMES

Abstract Background Physical activity has been associated with positive health outcomes in those with Ulcerative Colitis (UC). The extent to which other more prominent behaviours occurring throughout the 24-hour day (i.e., sitting, standing, lying down, and stepping) are associated with UC outcomes is unknown. Purpose The purpose of this study was to explore whether objectively measured time spent sitting, lying down, standing, and stepping were associated with Total Mayo score (TMS), fecal calprotectin (FCP), and C-reactive protein (CRP) in patients with UC. Method Patients were recruited from the Foothills Medical Center in Calgary, Alberta and were given activPALTM accelerometers (PAL Technologies Limited, Glasgow, UK) to wear on their thigh for 7 days. Step count, sitting time, standing time, and time lying down (excluding sleep) were recorded for a minimum of 4 days, including at least one day on the weekend. TMS was used to determine disease activity and patients were categorized into normal/mild (TMS score &amp;lt;6) or moderate/severe (TMS score 6). FCP, a marker of gut inflammation, was measured using stool samples. Blood samples were collected to measure serum CRP, a marker of systemic inflammation. Univariate analysis of covariance (ANCOVA) was used to evaluate associations between the activPALTM daily activity variables, TMS, FCP (&amp;lt; or &amp;gt;250ug/g) and CRP (&amp;lt; or &amp;gt; 5 mg/L). Analyses were controlled for age, sex, body mass index (BMI), and antibiotic use. Result(s) Patients (N=29; 15 male, 14 female) were on average 38 years of age (SD=12.1). The average BMI was 26.2 kg/m2 (SD=3.2). Based on TMS, 14 had moderate/severe disease activity and 16 had normal/mild disease activity. Average CRP was 2.16 mg/L (SD=2.49) while the mean FCP was 954.5 ug/g (SD=1427.7). Patients recorded an average of 8,137 steps (SD=3,051) per day. Average standing time was 240 minutes (SD=84) per day, sitting time was 503 minutes (SD=131) per day, and time spent lying down was 527 minutes (SD=111) per day. FCP was negatively associated with step count (D=-2,134 steps, 95% CI: -4,360 to 93, p=0.06). Patients with lower FCP values (&amp;lt;250mg/g) spent 60 fewer minutes sitting (p=.25), and 52 more minutes standing (p=.12) during the day compared to patients with higher FCP values (&amp;gt;250mg/g). Patients with normal/mild disease severity (TMS &amp;lt;6) spent 83 fewer minutes per day sitting compared to those with moderate/severe disease severity (TMS &amp;gt;6, p=.12). CRP was not associated with any behavioural outcomes. Conclusion(s) In our study, daily steps appeared to be most strongly associated with FCP. While not statistically significant, patients with lower FCP reported less sitting and more standing compared to those with higher FCP. Future studies with larger sample sizes should continue to explore these activity behaviours and their potential associations with UC disease outcomes. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; Alberta's Collaboration of Excellence for Nutrition in Digestive Diseases (ASCEND) Disclosure of Interest B. Chiew: None Declared, K. Lyden Consultant of: PAL Technologies, the company that manufactures the activPAL device., A. Schick: None Declared, C. Ohland: None Declared, K. McCoy: None Declared, S. Kaur: None Declared, M. Yousuf: None Declared, L. Taylor: None Declared, M. Raman Shareholder of: LyfeMD – Director, Shareholder, Grant / Research support from: Pfizer, Takeda, Speakers bureau of: Fresenius Kabi, Pfizer, Mckesson, Takeda, Lupin, J. Vallance Grant / Research support from: Canada Research Chairs Program

The multicenter impacts of an emergency physician lead on departmental flow and provider experiences.

Emergency department (ED) flow impacts patient safety, quality of care and ED provider satisfaction. Throughput interventions have been shown to improve flow, yet few studies have reported the impact of ED physician leadership roles on patient flow and provider experiences. The study objective was to evaluate the impacts of the emergency physician lead role on ED flow metrics and provider experiences. Quantitative data about patient flow metrics were collected from ED information systems in two tertiary hospital EDs and analyzed to compare ED length of stay, EMS hallway length of stay, physician initial assessment time, 72-h readmission and left without being seen rates three months before and following emergency physician lead role implementation. ED flow metrics for adult patients at each site were analyzed independently using descriptive and inferential statistics, t tests and multivariable regression analysis. Qualitative data were collected via surveys from ED providers (physicians, nurses, and EMS) about their experiences working with the emergency physician leads and analyzed for themes about emergency physician leads impact. The number of ED visits was relatively stable pre-post at the Peter Lougheed Centre (Lougheed) but increased pre-post at the Foothills Medical Centre (Foothills). Post-intervention at Lougheed median ED length of stay decreased by 18min (p < 0.001) and at Foothills ED length of stay increased by 8min (p < 0.001). EMS length of stay at Lougheed decreased by 20min (p < 0.001), and at Foothills length of stay increased by 17min (p < 0.001). Themes in provider feedback were that emergency physician leads (1) facilitated patient flow, (2) impacted provider workload, and (3) supported patient flow and safety with early assessments, treatments and investigations. In this study, the emergency physician lead impacted ED flow metrics variably at different sites, but important learnings from provider experiences can guide future emergency physician lead implementation.

Caution-Do Not Attempt This at Home. Airway Pressure Release Ventilation Should Not Routinely Be Used in Patients With or at Risk of Acute Respiratory Distress Syndrome Outside of a Clinical Trial.

1 Department of Critical Care Medicine, University of Calgary and Alberta Health Services, ICU Administration - Ground Floor - McCaig Tower, Foothills Medical Center, Calgary, AB, Canada. 2 O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada. 3 Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada. 4 Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada. The authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: [email protected]

Ambulatory Pulmonary Artery Pressure Monitoring Reduces Costs and Improves Outcomes in Symptomatic Heart Failure: A Single-Centre Canadian Experience

BackgroundPulmonary artery pressure (PAP) monitoring reduces heart failure (HF) hospitalizations (HFHs) and improves quality of life in New York Heart Association (NYHA) class III HF. We evaluated the impact of PAP monitoring on outcomes and health spending in a Canadian ambulatory HF cohort. MethodsTwenty NYHA III HF patients underwent wireless PAP implantation at Foothills Medical Centre, Calgary, Alberta. Baseline, and 3-, 6-, 9-, and 12-month assessments of laboratory parameters, hemodynamics, 6-minute walk text and Kansas City Cardiomyopathy Questionnaire scores were collected. Healthcare costs 1 year pre- and post-implantation were collected from administrative databases. ResultsMean age was 70.6 years; 45% were female. Results were as follows: an 88% reduction in emergency room visits (P = 0.0009); an 87% reduction in HFHs (P < 0.0003); a 29% reduction in heart function clinic visits (P = 0.033), and a 178% increase in nurse calls (P < 0.0002). Questionnaire and 6-minute walk test scores at baseline vs last follow-up were 45.4 vs 48.4 (P = 0.48) and 364.4 vs 402.8 m (P = 0.58), respectively. Mean PAP at baseline vs follow-up was 31.5 vs 24.8 mm Hg (P = 0.005). NYHA class improved by at least one class in 85% of patients. Mean measurable HF-related spending preimplantation was CAD$29,814 per patient per year and postimplantation was CAD$25,642 per patient per year (including device cost). ConclusionsPAP monitoring demonstrated reductions in HFHs, and emergency room and heart function clinic visits, with improvements in NYHA class. Although further economic evaluation is needed, these results support the use of PAP monitoring as an effective and cost-neutral tool in HF management in appropriately selected patients in a publicly funded healthcare system.

Temporal Artery Biopsy Debate: Positive TAB Result Prolongs Steroid Use in Giant Cell Arteritis.

A retrospective chart review garnered patient demographics, symptoms, comorbidities, and steroid treatment duration in patients undergoing TAB at a single center. Steroid treatment was compared between TAB+ and TAB - patients. One hundred seven patients undergoing TAB were included. Patients were predominantly women (70.1%) with a median age of 74 years (46 -91). Of 107 TAB results, 74 (69.2%) were negative, 23 (21.5%) were positive, and 10 (9.3%) were found to be indeterminate. In TAB+ patients, the mean erythrocyte sedimentation rate was not significantly different than TAB - patients (60.2 versus 43.7, P = 0.45), nor was the median C-reactive protein (38.8 versus 18.1, P = 0.17). Regarding steroid use, both TAB+ and TAB - patients had a similarly high rate of prebiopsy steroid initiation (82.6% versus 70.3%, P = 0.32). More TAB+ patients remained on steroids at 6 weeks (95.0% versus 57.4%, P = 0.004), 6 months (95% versus 37.7%, P < 0.001), 1 year (65.0% versus 31.1%, P = 0.024), and 18 months (50.0% versus 19.7%, P = 0.045). By 2 years, the difference no longer met significance (35.0% versus 14.8%, P = 0.12). P = 0.12). TAB positivity does seem to influence maintenance of steroids up to 18 months after biopsy.

Commentary: Surgical Management of Peripheral Nerve Pathology in Patients With Neurofibromatosis Type 2.

*Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Ontario, Canada; ‡Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Correspondence: Rajiv Midha, MD, MSc, Foothills Medical Centre, University of Calgary, 1195-1403 29 St NW, Calgary, ABT2N 2T9, Canada. Email: [email protected]

Simultaneous versus rapid serial interventions in a hybrid operating suite for severely injured patients: a prospective evaluation of differences in RAPTOR techniques and outcomes.

Open surgical and percutaneous endovascular procedures aimed at arresting traumatic life-threatening hemorrhage are usually performed in rapid serial fashion by surgeons and interventional radiologists; truly simultaneous procedures require modifications in technique, workflow and team collaboration. The primary objective of this study was to prospectively audit outcomes in patients with ongoing hemorrhage who underwent truly simultaneous open and percutaneous procedures. We prospectively evaluated the cases of all severely injured patients who required an open and percutaneous procedure within the hybrid RAPTOR (resuscitation with angiography, percutaneous techniques and operative repair) suite at the Foothills Medical Centre, Calgary, Alberta, Canada, between Apr. 4, 2013, and Dec. 5, 2019. We compared outcomes between the truly simultaneous and rapid serial cases. Thirty-five patients (31 [89%] male, median age 46 yr, median Injury Severity Score 30, blunt mechanism in 26 cases [74%]) underwent a hybrid intervention in the RAPTOR suite to stop ongoing hemorrhage during the study period. Twenty-three patients (66%) had a rapid serial procedure, and 12 (34%) had a truly simultaneous procedure. Demographic characteristics were similar between the 2 groups. Compared to the rapid serial group, a higher proportion of patients in the truly simultaneous group were hemodynamically unstable (11 [92%] v. 13 [56%], p = 0.03) and required damage-control procedures (10 [83%] v. 12 [52%], p = 0.03). The time from hospital arrival to procedure initiation was shorter for the truly simultaneous group (mean 31 min v. 59 min, p = 0.02), and a lower proportion had initial radiologic studies (3 [25%] v. 16 [70%], p = 0.01). The median hospital length of stay, intensive care unit stay and mortality rate were similar between the 2 groups. Truly simultaneous open and percutaneous procedures to stop ongoing hemorrhage were unique in both patient and procedural details. For the most severely injured patients, the provision of truly simultaneous modalities is necessary to achieve clinical outcomes equivalent to those of less ill patients.

Progressive Vertebrobasilar Vasculopathy and Stroke Secondary to Giant Cell Arteritis.

HomeStrokeVol. 53, No. 9Progressive Vertebrobasilar Vasculopathy and Stroke Secondary to Giant Cell Arteritis No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessCase ReportRequest AccessFull TextProgressive Vertebrobasilar Vasculopathy and Stroke Secondary to Giant Cell Arteritis Yasamin Mahjoub, MD, Erica D. McKenzie, MD, Saher Raouf and Mohammed Almekhlafi, MD Yasamin MahjoubYasamin Mahjoub Correspondence to: Yasamin Mahjoub, MD, Foothills Medical Centre, 1403 29 St NW, Calgary, AB T2N 2T9. Email E-mail Address: [email protected] https://orcid.org/0000-0003-0898-3307 Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada. Search for more papers by this author , Erica D. McKenzieErica D. McKenzie https://orcid.org/0000-0003-4369-413X Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada. Search for more papers by this author , Saher RaoufSaher Raouf https://orcid.org/0000-0003-3338-7937 Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada. Search for more papers by this author and Mohammed AlmekhlafiMohammed Almekhlafi https://orcid.org/0000-0001-9550-8197 Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada. Search for more papers by this author Originally published15 Aug 2022https://doi.org/10.1161/STROKEAHA.122.039503Stroke. 2022;53:e435–e438FootnotesCorrespondence to: Yasamin Mahjoub, MD, Foothills Medical Centre, 1403 29 St NW, Calgary, AB T2N 2T9. Email [email protected]ca

Sternum-Sparing Left Ventricular Assist Device Insertion Reduces Perioperative Transfusions and Blood Loss: A Single-Centre Canadian Experience

BackgroundLeft ventricular assist devices (LVADs) improve survival and quality of life, as either destination therapy or a bridge to transplantation. Although less-invasive hemisternotomy approaches for LVAD implantation are well studied, only a paucity of data is available in the literature on sternum-sparing bilateral minithoracotomy (BMT). Our centre has one of Canada’s most extensive experiences with the BMT approach. Herein, we compared LVAD implantation via BMT with patients who received full median sternotomy or hemisternotomy. MethodsA single-centre retrospective review of data from Foothills Medical Centre (Calgary, Canada) was performed. Patients underwent LVAD insertion from 2012 to 2019, receiving either BMT (n = 11) or sternotomy (full median sternotomy or upper hemisternotomy with left minithoracotomy; n = 38). Intraoperative and early postoperative outcomes were assessed. ResultsPatients who received BMT had significantly fewer transfusions of red blood cells, fresh frozen plasma, and platelets. The BMT group had lower chest-tube output in the first 12 hours. No significant differences occurred in ventilation time, intensive care unit length of stay, mortality, stroke, or reoperation for bleeding. ConclusionsOutcomes suggest that sternum-sparing LVAD implantation is a feasible alternative to sternotomy, leading to less postoperative blood loss and transfusion in the early postoperative period. Less transfusion is particularly valuable in this patient population, to reduce antigen-related sensitization prior to transplantation. Additional study is needed to assess potential benefits related to right heart function, postoperative mobility, and re-entry for transplantation.

Should Primary Stroke Centers Perform Advanced Imaging?

Should Primary Stroke Centers Perform Advanced Imaging?

Results From a Physical Activity Intervention Feasibility Study With Kidney Inpatients.

Background:Individuals with end-stage kidney disease requiring dialysis are often physically inactive, resulting in reduced physical functioning, increased frailty, and reduced quality of life. Furthermore, extended hospital stays and frequent readmissions are common, exacerbating health care costs. Physical activity may improve physical functioning, disability, and frailty but is not part of standard care of patients requiring dialysis. Research is required to determine the feasibility of implementing physical function assessments and physical activity programs in kidney inpatients requiring dialysis.Objective:To assess the feasibility and preliminary efficacy of an early-physical activity intervention (Move More study) in the care of kidney inpatients requiring dialysis. It was hypothesized that the intervention would be feasible with regards to administration and participation, meeting a priori feasibility criteria, and that kidney inpatients would benefit from participating.Design:Pilot study.Setting:Patient Unit 37, Foothills Medical Center, Calgary, AB, Canada.Patients:Kidney in-patients receiving dialysis.Measurements:Feasibility data were collected for recruitment, participation, assessment completion, physical activity completion, and adverse events. Participant and healthcare practitioner (HCP) satisfaction with the intervention was assessed using a questionnaire. Frailty and physical function were assessed by the kinesiologist at baseline and postintervention prior to hospital discharge.Methods:The study was a single-arm pilot intervention examining feasibility and preliminary efficacy. Kidney inpatients requiring dialysis were recruited to an individualized in-hospital physical activity intervention for the duration of their hospital stay. The intervention was led by a kinesiologist and supported by the clinical care team, including physiotherapists and nurse clinicians. Individualized exercise programs were created for patients to perform daily during their stay. These programs focused on strength, mobility, balance, and general movement and were tailored to each patient’s needs.Results:Thirty-six percent of eligible patients (n = 23/64) consented to participate in the Move More study, of whom 78% (n = 18/23) completed the intervention. The a priori level for consent to participate in the intervention was set at 60%. In addition, the a priori level for completion of assessments pre and postintervention was 50%. Ninety-five percent (n = 22/23) of preintervention assessments were completed compared to 65% of postintervention assessments. All participants who completed the survey (100%, n = 14/14) and most of the staff (77%, n = 24/31) reported being satisfied or very satisfied with the program. There were no adverse events related to the intervention. On average, Move More patients demonstrated improvements in frailty status and specific subsets of quality of life.Limitations:Firstly, as a feasibility study, the research was not powered to address the effectiveness of the intervention and lacked a comparison group to definitively link observed changes to the intervention itself. The voluntary nature of recruitment may have been biased toward ESKD inpatients with above-average motivation and baseline function. Furthermore, the small sample size from a single site limits the generalizability of findings. An additional limitation was the fact that postassessments were missed on a large number of patients, due to them being discharged prior to research staff knowing and being able to complete the assessments. Finally, studying the length of stay across the institution, as opposed to just the individual ward, would provide insight into hospitalization impact for these patients.Conclusions:The administration of and participation in a physical activity intervention for kidney inpatients requiring dialysis was initially not feasible primarily due to low recruitment and adherence challenges. The study was modified by including a research team member on the unit to increase recruitment efforts and support exercise adherence. The intervention impact includes potentially benefits on frailty and quality of life.

Association between antiseizure medications and quality of life in epilepsy: A mediation analysis.

The relationship between antiseizure medications (ASMs), which improve health outcomes by controlling seizures, and health-related quality of life (HRQOL) is poorly understood and may involve intermediate variables. We evaluated the potential mediators of the association between ASMs and HRQOL. Data are from an outpatient registry of adult patients with epilepsy seen at the Foothills Medical Center, Calgary, Alberta, Canada. Quality of life was measured using the 10-item Quality of Life in Epilepsy, and depression was measured using the Neurological Disorders Depression Inventory for Epilepsy. Propensity score matching was used to adjust for covariate imbalance between patients who received a single ASM (monotherapy) and those who received two or more ASMs (polytherapy) due to confounding. Mediation analysis was used to estimate the mediating effects of depression and ASM side effects on the association between patients' ASM polytherapy and HRQOL. Of 778 patients included in this analysis, 274 (35.2%) were on two or more ASMs. Patient-reported depression and ASM side effects jointly mediated the association between ASMs and HRQOL; these mediators accounted for 42% of the total average effect of ASM polytherapy ( =-13.6, 95% confidence interval = -18.2 to -8.6) on HRQOL. These findings highlight the importance of managing depression and ASM side effects for improving health outcomes of patients requiring treatment with ASMs. Intervention programs aimed at improving HRQOL of patients with epilepsy need to target these potential mediators.