This is a single-center, non-blinded, prospective, pilot study enrolling patients admitted to the critical care unit at Royal Columbian Hospital. This study investigates the effects of universal nasal decolonization using antimicrobial photodynamic therapy (aPDT) on the prevention of hospital-acquired pneumonia (HAP), ventilator-acquired pneumonia (VAP), and hospital-acquired bloodstream infection (BSI) in this patient population.
Main Objectives include:
* To determine whether a large, multi-center RCT of this protocol is feasible
* To determine baseline rates of VAP, HAP, and ICU-acquired BSI
* To gather preliminary efficacy data regarding VAP, HAP, and ICU-acquired BSI prevention using universal aPDT nasal decolonization
* To gather preliminary microbiological data on the effect of universal aPDT procedures on nasal carriage of various microoganisms in ICU patients.

开始日期2025-03-31

申办/合作机构

Fraser Health Authority

[+2]

NCT06856161

/ Not yet recruitingN/AIIT

A Novel Blood Test As a Differential Diagnosis and Drug Efficacy Biomarker in Mental Health

This longitudinal, observational study aims to assess whether the characteristics of a novel blood peripheral biomarker can serve as indicators for depression and schizophrenia in patients at the Royal Columbian Hospital Psychiatric Clinics. The study will evaluate whether changes in these biomarker characteristics can help distinguish between depressed patients who do or do not respond to treatment and between individuals experiencing a single psychotic episode and those at risk of progressing to schizophrenia. To achieve this, blood samples and standardized mental health assessments will be collected across three study visits from up to 500 participants, grouped into two study arms based on their diagnosis: Depression (DEP) or Psychosis/Schizophrenia (PSY).

开始日期2025-03-15

申办/合作机构

Fraser Health Authority

[+1]

NCT04487548

/ Active, not recruitingN/AIIT

Perioperative Smoking Cessation BUndle in a Tertiary Care Hospital - Can Turning Virtual Improve Outcomes? A Pilot Randomized Controlled Trial.

Smoking continues to be a burden to the healthcare system in Canada. It is well-known that smokers suffer more complications and higher risk of mortality after surgery than non-smokers. A quality improvement project at Royal Columbian Hospital recently showed that it is possible to implement a smoking cessation bundle for all current smokers during their preadmission clinic visit. However, due to the COVID-19 pandemic, much of the bundle was abandoned as it relied heavily on in-person interactions. The investigators wish to study the effect of a structured smoking cessation bundle, delivered remotely, on smoking cessation and postoperative complications. The aim is to determine the feasibility of giving the remotely delivered bundle to elective surgical patients before or around the time of a preadmission clinic visit, and whether it can reduce smoking rates and postoperative complications versus the standard uncoordinated advice.

开始日期2022-02-24

申办/合作机构

Fraser Health Authority

[+1]

100 项与 Royal Columbian Hospital 相关的临床结果

登录后查看更多信息

0 项与 Royal Columbian Hospital 相关的专利（医药）

登录后查看更多信息

537

项与 Royal Columbian Hospital 相关的文献（医药）

2025-03-13·New England Journal of Medicine

Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections

Article

作者: Reeve, Brenda ; Rishu, Asgar ; Davis, Joshua ; Reynolds, Steven ; Kandel, Christopher ; Elsayed, Sameer ; Prazak, Josef ; Choong, Keat ; Sligl, Wendy ; Stelfox, Henry T ; Marshall, John ; Pinto, Ruxandra ; Lee, Todd C ; Tsang, Jennifer ; Detsky, Michael ; Morpeth, Susan ; Duan, Erick ; Cook, Deborah ; Graham, Christopher ; Martin, Claudio ; Yahav, Dafna ; Shehabi, Yahya ; Havey, Tom ; Neary, John ; Khwaja, Kosar ; Das, Pavani ; Lauzier, Francois ; Kumar, Anand ; Sullivan, Richard ; Downing, Mark ; Lother, Sylvain ; Commons, Robert J ; Naud, Jean-Francois ; Daley, Peter ; O'Callaghan, Kevin ; Miyakis, Spiros ; Cirone, Robert ; Fowler, Robert A ; Wood, Gordon ; Al Johani, Sameera ; Rogers, Benjamin A ; Roberts, Sally ; Grant, Jennifer ; Paterson, David ; Turgeon, Alexis ; McGuinness, Shay ; Belley-Cote, Emilie ; Conly, John ; Binnie, Alexandra ; Zarychanski, Ryan ; Evans, Gerald ; Lamontagne, Francois ; Charbonney, Emmanuel ; Kazemi, Alex ; Daneman, Nick ; Ball, Ian ; Kagan, Ilya ; Singhal, Nishma ; Carignan, Alex ; Lawrence, Cassie ; Geagea, Anna ; Hoffman, Tomer ; Eustace, Matthew ; Powis, Jeff E ; MacFadden, Derek R ; Coburn, Bryan ; Morris, Andrew ; Shin, Phillip ; Dwivedi, Dhiraj B ; Dodek, Peter ; Hall, Richard ; Arabi, Yaseen ; McDonald, Emily G ; Bagshaw, Sean M ; Friedrich, Jan O ; Kwok, Clement ; Muscedere, John ; Litton, Edward ; Buehner, Ulrike ; Parke, Rachael ; Alraddadi, Basem ; McArthur, Colin ; Whitlock, Richard ; McIntyre, Lauralyn ; Gupta, Sachin ; Tiruvoipati, Ravindranath ; Fralick, Michael ; Aslanian, Pierre ; Williams, Anthony ; Young, Paul ; Shum, Omar

BACKGROUNDBloodstream infections are associated with substantial morbidity and mortality. Early, appropriate antibiotic therapy is important, but the duration of treatment is uncertain.METHODSIn a multicenter, noninferiority trial, we randomly assigned hospitalized patients (including patients in the intensive care unit [ICU]) who had bloodstream infection to receive antibiotic treatment for 7 days or 14 days. Antibiotic selection, dosing, and route were at the discretion of the treating team. We excluded patients with severe immunosuppression, foci requiring prolonged treatment, single cultures with possible contaminants, or cultures yielding Staphylococcus aureus. The primary outcome was death from any cause by 90 days after diagnosis of the bloodstream infection, with a noninferiority margin of 4 percentage points.RESULTSAcross 74 hospitals in seven countries, 3608 patients underwent randomization and were included in the intention-to-treat analysis; 1814 patients were assigned to 7 days of antibiotic treatment, and 1794 to 14 days. At enrollment, 55.0% of patients were in the ICU and 45.0% were on hospital wards. Infections were acquired in the community (75.4%), hospital wards (13.4%) and ICUs (11.2%). Bacteremia most commonly originated from the urinary tract (42.2%), abdomen (18.8%), lung (13.0%), vascular catheters (6.3%), and skin or soft tissue (5.2%). By 90 days, 261 patients (14.5%) receiving antibiotics for 7 days had died and 286 patients (16.1%) receiving antibiotics for 14 days had died (difference, -1.6 percentage points [95.7% confidence interval {CI}, -4.0 to 0.8]), which showed the noninferiority of the shorter treatment duration. Patients were treated for longer than the assigned duration in 23.1% of the patients in the 7-day group and in 10.7% of the patients in the 14-day group. A per-protocol analysis also showed noninferiority (difference, -2.0 percentage points [95% CI, -4.5 to 0.6]). These findings were generally consistent across secondary clinical outcomes and across prespecified subgroups defined according to patient, pathogen, and syndrome characteristics.CONCLUSIONSAmong hospitalized patients with bloodstream infection, antibiotic treatment for 7 days was noninferior to treatment for 14 days. (Funded by the Canadian Institutes of Health Research and others; BALANCE ClinicalTrials.gov number, NCT03005145.).

2025-03-01·Clinical Research in Cardiology

Safety and feasibility of early discharge after transcatheter aortic valve implantation with ACURATE Neo—the POLESTAR trial

Article

作者: Wykyrzykowska, Joanna ; Hildick-Smith, David ; Rosseel, Liesbeth ; Van Der Heyden, Jan ; Cornelis, Kristoff ; Voskuil, Michiel ; Vandeloo, Bert ; Cunnington, Michael ; Wijeysundera, Harindra C ; Wood, David ; van der Kley, Frank ; Kovac, Jan ; Rensing, Benno ; Van Mieghem, Nicolas M ; Chan, Albert ; Ooms, Joris F

AbstractBackgroundTranscatheter aortic valve implantation (TAVI) serves a growing range of patients with severe aortic stenosis (AS). TAVI has evolved to a streamlined procedure minimizing length of hospital stay.AimsTo evaluate the safety and efficacy of an early discharge (ED) strategy after TAVI.MethodsWe performed an international, multi-center, prospective observational single-arm study in AS patients undergoing TAVI with the ACURATE valve platform. Eligibility for ED was assessed prior to TAVI and based on prespecified selection criteria. Discharge ≤ 48 h was defined as ED. Primary Valve Academic Research Consortium (VARC)-3-defined 30-day safety and efficacy composite endpoints were landmarked at 48 h and compared between ED and non-ED groups.ResultsA total of 252 patients were included. The median age was 82 [25th–75th percentile, 78–85] years and the median Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score was 2.2% [25th–75th percentile, 1.6–3.3]. ED and non-ED were achieved in 173 (69%) and 79 (31%) patients respectively. Monitoring for conduction disturbances was the principal reason for non-ED (33%). Overall, at 30 days, all-cause mortality was 1%, new permanent pacemaker rate was 4%, and valve- or procedure-related rehospitalization was 4%. There was no difference in the primary safety and efficacy endpoint between the ED and non-ED cohorts (OR 0.84 [25th–75th percentile, 0.31–2.26], p = 0.73, and OR 0.97 [25th–75th percentile, 0.46–2.06], p = 0.94). The need for rehospitalization was similarly low for ED and non-ED groups.ConclusionEarly discharge after TAVI with the ACURATE valve is safe and feasible in selected patients. Rhythm monitoring and extended clinical observation protracted hospital stay.Graphical AbstractSafety and feasibility of early discharge after transcatheter aortic valve implantation with ACURATE Neo, an international multi-center, prospective observational single-arm study. OR, odds ratio (95% confidence interval); VARC, Valve Academic Research Consortium

2025-02-01·Stroke

Abstract WMP100: Multicenter Validation Study of Robot-Assisted Transcranial Doppler (raTCD) for Enhanced Right-to-Left Shunt Detection Compared to Transthoracic and Transesophageal Echocardiography

作者: Shah, Ruchir ; Medvedev, George ; Naidoo, Vishaya ; Chang, Ira ; Yadlapati, Ajay ; Hernandez, Sean ; Schnapp, william ; Walker, Gregory ; Devlin, Thomas ; Pirahanchi, Yasaman ; Devlin, Christian ; Khan, Razi

Background: Cryptogenic strokes account for approximately 30-40% of all stroke cases, underscoring the critical need for effective identification of right-to-left shunt (RLS) and PFO. The recently published BUBL Study (NCT04604015), a multicenter, prospective trial, demonstrated a 3-fold increase in the detection of RLS/PFO using raTCD compared TTE. Wechsler recognized the study's important findings in an accompanying editorial, while also highlighting the need for further validation through additional studies. This study aims to provide robust real-world data to further substantiate the findings of the BUBL Study. Methods: This study involved a multicenter retrospective analysis of prospectively collected real-world clinical data across 5 centers in the US and Canada. The inclusion criterion was any patient who underwent raTCD for RLS detection as part of their stroke evaluation. A standardized TCD, TTE, and TEE bubble study protocol was consistently applied. Key outcomes include overall and large (Spencer Grade ≥3) RLS detection rates for raTCD, detection rates comparison between matched raTCD, TTE, and TEE. Results: A total of 1,372 patients underwent raTCD, with 455 and 114 had matched TTE and TEE respectively. The overall cohort had a mean age of 55.5 ± 13.3 yrs, with 44% female. Using raTCD, RLS was detected in 54% (735/1,372) and large RLS in 28% (383/1,372) of the overall population. When compared with TTE (n=455), raTCD identified 1.7 times more cases of RLS/PFO (56.7% vs. 33.2%, p<0.001 – Table 1). For all and large RLS detected by raTCD, 27.4% (125/455) and 12.3% (56/455), respectively were negative on TTE. Comparing TEE and raTCD, 14.9% (17/114) were negative on TEE but positive on raTCD compared to 5.3% (6/114) which were positive on TEE and negative on raTCD. Overall, using TEE as the “gold standard” raTCD reported a SEN of 92.1%. For the overall population (n=1,372) TTE and TEE status was unknown for 917 patients and will subsequently be investigated. Conclusions: This study represents the largest real-world study to date, validating raTCD against traditional diagnostic modalities. The study showed that raTCD detected 1.7 times the number of positive RLS/PFO compared to TTE, revealing the limitations of TTE as a screening modality for PFO in cryptogenic stroke. These results build upon the prospective multicenter BUBL Study reinforcing the imperative to incorporate raTCD into a new diagnostic algorithm for cryptogenic stroke workup.

100 项与 Royal Columbian Hospital 相关的药物交易

登录后查看更多信息

100 项与 Royal Columbian Hospital 相关的转化医学

登录后查看更多信息