Sedation Practice in Intensive Care Evaluation (SPICE IV) Early Sedation with Dexmedetomidine Vs. Placebo in Older Ventilated Critically Ill Patients: a Prospective, Multi-Centre, Double-Blind, Randomized, Controlled Trial

Sedation remains a ubiquitous and crucial component of intensive care treatments in critically ill mechanically ventilated patients. Sedation relieves anxiety, reduces distress, and promotes tolerance of endotracheal intubation and associated life-sustaining interventions such as mechanical ventilation, cardiovascular assistance, and renal support. Thus, choosing the optimal sedative agent is vital to patient comfort, safety, and survival. Despite more than 20 years of intensive care sedation research, there is still no consensus on what constitutes best sedation practice. The Society of Critical Care Medicine, the premier critical care organisation in North America, published the 2018 Clinical Practice Guidelines on the management of Pain, Agitation/Sedation, Delirium, Immobility and Sleep (PADIS) disruption (chaired by our primary applicant W.A.) and issued weak recommendations to provide analgesia before sedation, to target light sedation whenever clinically feasible, and to use either dexmedetomidine or propofol over midazolam for the sedation of mechanically ventilated critically ill patients. Similarly, the American Thoracic Society produced a set of Clinical Practice Guidelines to promote liberation and weaning from mechanical ventilation in critically ill patients, with weak recommendations for the use of non-benzodiazepines as primary sedatives and to target light sedation when clinically possible. A weak recommendation was issued in an Intensive Care Medicine Rapid Practice Guideline published in 2022 to use dexmedetomidine over propofol for sedation of critically ill adults, if the desired outcome is a reduction in delirium. These guidelines, however, do not consider age-dependent pharmacokinetics and pharmacodynamics, illness severity, timing of sedative administration, operative vs medical reason for admission, or the changing dynamics of sedation practice at different phases of critical illness. The lack of high-level evidence to inform sedation practice in the critically ill has led to approaches that are mainly opinion-based and lack the support of evidence from large multicentre, international randomised clinical trials.

开始日期2025-01-31

申办/合作机构

St. Joseph's Healthcare Hamilton

NCT06259565 / Not yet recruiting临床3期IIT

Non-invasive Ventilation and Dexmedetomidine in Critically Ill Adults: an International Pragmatic Randomized Controlled Trial (inDEX Trial)

Non-Invasive ventilation (NIV) is a life saving intervention for patients with acute respiratory failure (ARF). Some patients are not able to tolerate the NIV intervention and ultimately fail, requiring the use of invasive mechanical ventilation (IMV) and intubation. Sedation may improve a patient's NIV tolerance. However, this practice has not been adopted by intensivists as the risk of over-sedation resulting in respiratory depression, inability to protect the airway, and inadvertent need for intubation are all large deterrents of sedative use in NIV.
The Non-invasive Ventilation and Dexmedetomidine in Critically Ill Adults: a Pragmatic Randomized Controlled Trial (inDEX) is looking to evaluate the effectiveness of dexmedetomidine compared to placebo in reducing non-invasive ventilation failures in patients admitted to the hospital with acute respiratory failure.

开始日期2025-01-31

申办/合作机构

St. Joseph's Healthcare Hamilton

NCT06540196 / Not yet recruitingN/AIIT

The Development, Safety, and Feasibility of an Artificial Intelligence-Powered Platform (NodeAI) for Real-Time Prediction of Mediastinal Lymph Node Malignancy During Endobronchial Ultrasound Staging for Lung Cancer

Lung cancer is the leading cause of annual cancer deaths globally, more than breast, prostate, and colon cancers combined. The staging of chest lymph nodes (LNs) is a crucial step in the lung cancer diagnostic pathway because it aids in treatment decisions - whether a patient is a candidate for lung resection, chemotherapy, radiation, or multimodal treatments. Endobronchial Ultrasound Transbronchial Needle Aspiration (EBUS-TBNA) is the current standard for chest nodal staging for non-small cell lung cancer (NSCLC), and guidelines mandate that Systematic Sampling (SS) of at least 3 chest LN stations be routinely performed for accurate staging. Unfortunately, EBUS-TBNA yields inaccurate results in 40% of patients, leading to misinformed treatment decisions. This proportion is much higher in patients with Triple Normal LNs [LNs that appear normal on computed tomography (CT) scans, positron emission tomography (PET) scans, and EBUS], which have been found to have a > 93% chance of being truly benign. This is because EBUS-TBNA is based on ultrasound, whose success highly depends on the skill of the person performing it (operator). When the operator makes an error, the entire procedure is jeopardized. This causes downstream delays in treatment due to repeated testing and ill-informed treatment decisions.
Over the past decade, the investigator has been conducting a series of research studies and trials: the development and validation of the Canada Lymph Node Score (CLNS) - a surgeon-derived semi-quantitative measure of LN malignancy; an Artificial Intelligence (AI)-based version of the CLNS to predict malignancy; and a fully autonomous AI that learned to predict malignancy directly from ultrasound images, to introduce AI to the decision-making pathway in NSCLC. This resulted in the creation of an AI-powered software to predict malignancy in mediastinal LNs of patients with lung cancer. The software is currently housed in cloud storage and its applications are latent - which means that LN images must be uploaded to the software, and results are received at a future time. In its current form, the software is not ready for clinical application due to this latency. In this project, the investigator aims to build a point-of-care device which will house the software (NodeAI) and deliver real-time results to the surgeon, and this device will be tested in a clinical trial.

开始日期2025-01-01

申办/合作机构

St. Joseph's Healthcare Hamilton

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项与 St. Joseph's Healthcare Hamilton 相关的文献（医药）

2024-07-01·International Journal of Gynecologic Cancer

Validating the diagnostic accuracy of an MRI-based scoring system for differentiating benign uterine leiomyomas from leiomyosarcomas

Article

作者: Alabousi, Abdullah ; Al Ajmi, Hawra ; Alrahbi, Nasser ; Al Salmi, Ahmed ; Al Salmi, Ishaq ; Haider, Ehsan ; Al Hadidi, Aymen ; Al Khuri, Maryam ; Jose, Sachin ; Vasudev, Pooja

ObjectiveUterine leiomyomas are the most common benign uterine tumors. They are difficult to distinguish from their malignant counterparts—smooth muscle tumors of unknown malignant potential (STUMP) and leiomyosarcoma. The purpose of this study is to propose and validate the diagnostic accuracy of the MRI-based Oman-Canada Scoring System of Myometrial Masses (OCSSMM) to differentiate uterine leiomyomas from STUMP/leiomyosarcomas.MethodsThis is a retrospective study performed at two tertiary care centers. All patients with a pathology-proven uterine mass who underwent pre-operative pelvic MRI between January 2010 and January 2020 were included. Using a 1.5T MRI machine, sequences included were axial/coronal/sagittal T2 and T1 weighted imaging, axial diffusion weighted and apparent diffusion coefficient map, and axial or sagittal dynamic contrast-enhanced sequences. A scoring system was designed based on previously published worrisome MRI features for uterine leiomyosarcoma. Each feature was allocated a score from 0 to 2 according to the strength of association with malignancy. Subsequently, the MR images were blindly and independently reviewed by a fellowship-trained radiologist and a clinical fellow/senior resident. Each uterine mass was scored according to their imaging features. The scores were divided into five categories according to the sum of scores. Category III and above was considered positive for leiomyosarcoma/STUMP. Sensitivity, specificity, and positive and negative predictive values were calculated.ResultsA total of 244 women were included (age range 20–74 years, mean 40). Of these, 218 patients had benign leiomyoma, 13 had STUMP, and 13 had leiomyosarcoma. The sensitivity and specificity of the scoring system were 92.3% and 64.7%, respectively. The negative predictive value was 98.6%. No leiomyosarcoma was missed using this scoring system. The presence of non-cystic T2 hyperintensity or diffusion restriction in a uterine mass were the most sensitive signs of a leiomyosarcoma/STUMP.ConclusionThe proposed multi-parametric MRI scoring system may be useful in differentiating benign uterine leiomyomas from leiomyosarcomas/STUMP.

2024-07-01·HAND

Routine Pathological Examination of Clinically Presumed Dupuytren Disease: Does It Add Value?

Article

作者: Uhlman, Kathryn ; Naqvi, Asghar ; Thoma, Achilles ; Murphy, Jessica ; Duku, Eric ; Bonert, Michael

Background: In surgery for Dupuytren disease (DD), palmar fascia specimens are routinely submitted for pathological evaluation. The purpose of this study was to determine the rate of discordant diagnosis and the value of, and costs associated with, routine pathological analysis of palmar fascia tissue extracted in surgery for clinically diagnosed DD. Methods: All pathology reports for in-house palmar fascia specimens obtained in surgery for clinically diagnosed DD (time period: January 2001 to December 2020) were retrieved from one academic institution. All specimens were classified by a hierarchical free-text string matching algorithm (HFTSMA) and searched for evidence of malignancy. The primary outcome was percentage of concordant, discrepant, and discordant diagnoses. Secondary outcomes included anatomical location and costs. The HFTSMA was used to capture the anatomical location. Costs included professional, laboratory processing, and ancillary fees based on the Ontario Schedule of Benefits. Results: The search retrieved 1323 pathology reports, with 1480 palmar fascia specimens, from 1078 individual patients. By diagnosis, 96.1% of specimens (1422/1480) were concordant (fibromatosis), 3.9% (58/1480) were discrepant (scarring/fibrosis, benign fascia/connective tissue, or other benign findings), and 0% (0/1480) were discordant. The most common location was ring finger (n = 381, 48.7%). Ancillary testing was minimal. The cost per palmar fascia specimen was estimated to be CAD $34.57. The institutional costs were approximately CAD $2558.18/year. Conclusions: Routine pathological examination of specimens in cases of clinically diagnosed DD does not yield additional clinically important findings and may not warrant their costs.

2024-06-01·Dysphagia

Identifying Non-Traditional Approaches to Swallowing Rehabilitation: A Scoping Review

Review

作者: Namasivayam-MacDonald, Ashwini ; Badesha, Maneetpal ; Boyce, Keara ; Najeeb, Hiba ; Horyacheva, Angela ; Kerr, Cassandra

In recent years, dysphagia care has shifted toward a more patient-centered approach. This means that dysphagia clinicians are considering more factors in the treatment process including the goals of care, quality of life, and cultural values. The purpose of this scoping review was to examine relevant research and identify dysphagia interventions outside of those traditionally used by dysphagia clinicians that may improve swallowing function. A review of relevant studies was conducted using search terms related to swallowing and treatment. The search yielded 8439 unique studies. Of the 283 articles that underwent a full-text review, 37 articles were included in the final review. These articles highlighted three potential areas of non-traditional dysphagia intervention that may serve to provide holistic care, while also aiming to improve swallowing mechanisms: acupuncture and Eastern medicine interventions, vocal exercises, and physical function exercises. The results suggest that dysphagia clinicians should work collaboratively with other allied health professionals and consider non-traditional approaches to dysphagia care. Through the identification of potentially effective but non-traditional or non-Eurocentric interventions for dysphagia care, clinicians may promote a culturally relevant, patient-centered approach, in turn increasing patient acceptance of treatment plans and compliance. Future research should explore the efficacy and feasibility of these interventions in dysphagia rehabilitation, as well as their effectiveness compared to more traditional approaches.

项与 St. Joseph's Healthcare Hamilton 相关的新闻（医药）

2023-12-07

·Business Wire

Prime Healthcare Hospitals Earn 2023 Leapfrog Top Hospital Award for Outstanding Quality and Safety

ONTARIO, Calif.--( BUSINESS WIRE )--Two Prime Healthcare hospitals have been named 2023 Top Hospitals nationally by The Leapfrog Group, a designation widely acknowledged as one of the most prestigious awards American hospitals can receive for patient safety and quality. Montclair Hospital Medical Center, a not-for-profit member of Prime Healthcare Foundation, was one of only six hospitals in California to receive the "Top General Hospital" award. Garden City Hospital, a member of Prime Healthcare, was one of only three hospitals in Michigan recognized as a "Top Teaching Hospital." More than 2,100 hospitals were considered for the award. A total of 132 Top Hospitals were selected, including: 8 Top Children's 35 Top General 15 Top Rural 74 Top Teaching "Protecting patients from preventable harm is the cornerstone of The Leapfrog Group's mission," said Leah Binder, president and CEO of The Leapfrog Group. "These two Prime Healthcare hospitals have demonstrated that patient safety is their top priority, and we're truly pleased to recognize them as a Top Hospital this year. Congratulations to hospital staff at all levels who made this national recognition possible." These recognitions follow the recent release of the Leapfrog Hospital Safety Grades, which awarded 27 Prime Healthcare hospitals in 13 states with "A" Hospital Safety Grades. The letter grades are assigned to all general hospitals across the country based on their performance in preventing medical errors, injuries, accidents, infections and other harms to patients in their care. Montclair Hospital Medical Center has earned an 'A' grade in patient safety from The Leapfrog Group five times since Spring 2020. In addition to exceeding standards for patient safety, the hospital earned national recognition for efforts to improve management of heart failure by the American Heart Association. In addition, Montclair Hospital received "100 Top Hospital" recognition from IBM Watson Health four times. "We strive to create an environment conducive to compassionate care, and we take every measure to ensure that our patients receive the best possible treatment," said Gail Aviado, CEO of Montclair Hospital Medical Center. "Thank you to our dedicated staff and physicians. This recognition is a testament to their commitment and ability to deliver personalized care with exceptional outcomes for our patients." Garden City Hospital has been nationally recognized over the years for its clinical excellence, and more than 80 medical residents benefit from exceptional training experiences in a nationally ranked hospital setting. The accredited program began more than 50 years ago, and residency training programs include: Emergency Medicine, Orthopedic Surgery, Neurology, Internal Medicine, Family Medicine, General Surgery and a Cardiology Fellowship. "Recognition for delivering on our mission is an honor," said Saju George, CEO of Garden City Hospital. "Our steadfast commitment to patient safety, clinical outcomes, physician training and quality care will always remain at the forefront. Thank you to all our caregivers for this remarkable achievement in ensuring safe, compassionate care for our communities." The following Prime Healthcare hospitals received Fall 2023 'A' Hospital Safety Grade: Centinela Hospital Medical Center , Inglewood, CA; Coshocton Regional Medical Center , Coshocton, OH; Dallas Regional Medical Center , Mesquite, TX; East Liverpool City Hospital , East Liverpool, OH; Garden City Hospital , Garden City, MI; Harlingen Medical Center , Harlingen, TX; Knapp Medical Center , Weslaco, TX; La Palma Intercommunity Hospital , La Palma, CA; Landmark Medical Center , Woonsocket, RI; Lake Huron Medical Center , Port Huron, MI; Mission Regional Medical Center , Mission, TX; Montclair Hospital Medical Center , Montclair, CA; Monroe Hospital , Bloomington, IN; Pampa Regional Medical Center ; Pampa, TX; Paradise Valley Hospital , National City, CA; Providence Medical Center , Kansas City, KS; Riverview Regional Medical Center , Gadsden, AL; Roxborough Memorial Hospital , Philadelphia, PA; Saint Clare's Denville Hospital ; Denville, NJ Saint Mary's Regional Medical Center , Reno, NV; Sherman Oaks Hospital , Sherman Oaks, CA; Southern Regional Medical Center , Riverdale, GA ; St. Joseph Medical Center , Kansas City, MO; St. Mary's General Hospital , Passaic, NJ; St. Mary's Medical Center , Blue Springs, MO; Suburban Community Hospital , Norristown, PA; and West Anaheim Medical Center , Anaheim, CA. "Earning an 'A' grade means 27 of Prime Healthcare hospitals made a true commitment to put patients first," said Leah Binder, president and CEO of The Leapfrog Group. "We congratulate the leadership, Board, clinicians, staff and volunteers that all had a role to play in this achievement." To see full grade details and a list of institutions honored as 2023 Top Hospitals, visit https://www.leapfroggroup.org/ . About Prime Healthcare and Prime Healthcare Foundation: Prime Healthcare is an award-winning health system operating 45 hospitals and more than 300 outpatient locations in 14 states, providing over 2.6 million patient visits annually. It is one of the nation's leading health systems with nearly 50,000 employees and physicians dedicated to providing the highest quality healthcare. Fourteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation , a 501(c)(3) not-for-profit public charity. Based in Ontario, California, Prime Healthcare is nationally recognized for award-winning quality care and has been named a Top 10 and Top 15 Health System by PINC AI™ (formerly IBM Watson Health.) Its hospitals have been named among the nation's "100 Top Hospitals" 68 times and have received more Patient Safety Excellence Awards from Healthgrades than any other health system in the past eight years. To learn more, please visit www.primehealthcare.com . Find us on: LinkedIn: linkedin.com/company/prime-healthcare / Twitter: twitter.com/_PrimeHealth Facebook: facebook.com/primehealthcare / Instagram: instagram.com/prime_healthcare/

AHA会议

2023-03-21

·Business Wire

Prime Healthcare Celebrates Patient Safety Excellence Recognition from Healthgrades

ONTARIO, Calif.--( BUSINESS WIRE )--The majority of Prime Healthcare's community hospitals have been recognized by Healthgrades as 2023 Patient Safety Excellence Award™ recipients. This year marks the eighth year in a row that Prime Healthcare has had more patient safety excellence awards than any other health system (2016-2023), according to Healthgrades. "We at Healthgrades strive to help patients make informed decisions about their care and are grateful for Prime Healthcare's continued leadership in patient safety," said Dr. Brad Bowman, chief medical officer and head of data science at Healthgrades. "To have so many hospitals recognized for patient safety speaks to Prime's commitment to delivering exceptional care for the many communities they support. Through our 2023 Patient Safety Excellence Awards, we seek to recognize hospitals that excel in providing top-quality care for their patients while preventing serious injuries during hospital stays." During the 2019-2021 study period, 164,592 potentially preventable patient safety events occurred among Medicare patients in U.S. hospitals.* Healthgrades found that just four patient safety indicators accounted for 74% of all patient safety events: hip fracture due to an in-hospital fall, collapsed lung resulting from a procedure/surgery, pressure or bed sores acquired in the hospital, and catheter-related bloodstream infections acquired in-hospital. Healthgrades' analysis also revealed that patients treated in hospitals receiving the Healthgrades 2023 Patient Safety Excellence Award were, on average: 61.4%% less likely to experience an in-hospital fall resulting in hip fracture, than patients treated at non-recipient hospitals* 52.7% less likely to experience a collapsed lung resulting from a procedure or surgery in or around the chest, than patients treated at non-recipient hospitals* 66.1% less likely to experience pressure sores or bed sores acquired in the hospital, than patients treated at non-recipient hospitals* 67.3% less likely to experience catheter-related bloodstream infections acquired in the hospital, than patients treated at non-recipient hospitals* "Providing exceptional care and ensuring patient safety are at the core of our mission and has been especially critical these last several years throughout the pandemic. We are grateful that nearly all our hospitals were honored by Healthgrades," said Sunny Bhatia, MD, CEO of Region I and Corporate Chief Medical Officer for Prime Healthcare. "Recognition for delivering on our mission of clinical excellence is an honor. This recognition is a testament to the commitment of Prime Healthcare, its clinicians and staff to delivering exceptional outcomes for our patients." When it comes to choosing healthcare, quality saves lives, which is why Healthgrades is committed to delivering the most scientifically accurate and comprehensive information about doctors and hospitals — with data insights not available anywhere else. To that end, it's important for consumers to know that if all hospitals, as a group, performed similarly to the 2023 Patient Safety Award recipients, on average, 95,880 patient safety events could have been avoided. * “Congratulations to the staff and physicians of our Prime Healthcare Foundation hospitals that received this prestigious recognition,” said Kavitha Bhatia, MD, President and Chair of Prime Healthcare Foundation. “This is a true testament to Prime’s mission of bringing quality compassionate care to communities and promoting health equity.” The following Prime hospitals received recognition in the Healthgrades 2023 ratings: Centinela Hospital Medical Center , Inglewood, CA; Dallas Medical Center , Dallas, TX; Desert Valley Hospital , Victorville, CA; East Liverpool City Hospital , East Liverpool, OH; Encino Hospital Medical Center , Encino, CA; Garden Grove Hospital Medical Center , Garden Grove, CA; Harlingen Medical Center , Harlingen, TX; Lake Huron Medical Center , Port Huron, MI; Landmark Medical Center , Woonsocket, RI; Lehigh Regional Medical Center , Lehigh Acres, FL; Lower Bucks Hospital , Bristol, PA; Paradise Valley Hospital , National City, CA; Providence Medical Center , Kansas City, KS; Saint Clare's Denville Hospital , Denville, NJ; Saint Mary's Regional Medical Center , Reno, NV; Saint Michael's Medical Center , Newark, NJ; Shasta Regional Medical Center , Redding, CA; Sherman Oaks Hospital , Sherman Oaks, CA; St. Mary's General Hospital , Passaic, NJ; St. Mary's Medical Center , Blue Springs, MO; West Anaheim Medical Center , Anaheim, CA; Alvarado Hospital Medical Center , San Diego, CA; Huntington Beach Hospital , Huntington Beach, CA; La Palma Intercommunity Hospital , La Palma, CA; North Vista Hospital , North Las Vegas, NV; Roxborough Memorial Hospital , Philadelphia, PA; Suburban Community Hospital , East Norriton, PA. Consumers can visit healthgrades.com for more information on how Healthgrades measures hospital quality and access the complete methodology here . *Statistics are calculated from Healthgrades Patient Safety Ratings and Excellence Award methodology which is based primarily on AHRQ technical specifications (Version 2022.0.1) for MedPAR data years 2019 through 2021 and represent three-year estimates for Medicare patients only. About Prime Healthcare and Prime Healthcare Foundation: Prime Healthcare is an award-winning health system operating 45 hospitals and more than 300 outpatient locations in 14 states, providing over 2.6 million patient visits annually. It is one of the nation's leading health systems with nearly 50,000 employees and physicians dedicated to providing the highest quality healthcare. Fourteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation , a 501(c)(3) not-for-profit public charity. Based in Ontario, California, Prime Healthcare is nationally recognized for award-winning quality care and has been named a Top 10 and Top 15 Health System by IBM Watson Health. Its hospitals have been named among the nation's "100 Top Hospitals" 66 times and have received more Patient Safety Excellence Awards from Healthgrades than any other health system in the past seven years. To learn more, please visit www.primehealthcare.com . Find us on: LinkedIn: linkedin.com/company/prime-healthcare / Twitter: twitter.com/_PrimeHealth Facebook: facebook.com/primehealthcare / Instagram: instagram.com/prime_healthcare/

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