Alberta Health Services

Diabetic foot infections (DFIs) are a serious complication of diabetes, leading to high rates of hospital admission, amputation, and early death-particularly in persons living in resource-limited communities. Although the updated International Working Group on the Diabetic Foot guidelines in 2024 provide well-laid-out strategies for managing DFIs, these tend to be better suited for use in well-resourced centers. This case-based review discusses and applies these guidelines for an approach to DFI in real-world scenarios. It focuses on supporting health care providers working in community and resource-limited settings. The review explores how to recognize and diagnose DFI, including the use of imaging modalities, and how to distinguish soft tissue infection from bone infection or noninfectious entities. Management strategies are detailed regarding antibiotic considerations and approaches, including in resource-limited settings, and when other interventions or surgical referral may be important. Practical clinical cases are used to illustrate key points, emphasizing how care may be adapted based on the context. The authors also consider health equity aspects by identifying barriers that may be faced by patients who are from racialized backgrounds and live in resource-limited settings. The review aims to equip frontline wound clinicians with a pragmatic approach to managing DFIs that is grounded in up-to-date evidence framed in a real-world context.JOURNAL/aswca/04.03/00129334-202604000-00004/figure1/v/2026-03-10T151712Z/r/image-jpeg GENERAL PURPOSE: To provide clinicians with an evidence-based approach to the diagnosis and management of diabetic foot infections (DFIs). TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:Analyze evidence-based clinical and laboratory findings to accurately diagnose (DFIs) and diabetic foot osteomyelitis.Evaluate patient-specific clinical data to select evidence-based management strategies for patients with (DFIs) and diabetic foot osteomyelitis.

A rapid assessment was conducted, including a literature review and key informant interviews, to explore optimal staffing levels and factors influencing staffing decisions across public health jurisdictions in Canada, including strategic plans and priorities. The literature review found no current guidance to plan for future public health dietitian workforce needs. An outdated staffing benchmark (1 full-time equivalent [FTE] per 50,000 population) is still referenced in some sources. Twenty-nine individuals from 25 jurisdictions across nine provinces participated via interviews or email. Eleven jurisdictions had public health nutrition-related strategic plans, with common priorities. Staffing numbers from 21 jurisdictions ranged from 1 FTE per 32,000 to 1 FTE per 316,000. Additional staffing challenges that surfaced included lost positions due to attrition or transitions to other roles, insufficient staff for programme needs, increased complexity and inconsistencies in public health dietitian roles and responsibilities across jurisdictions. There is an urgent need for updated workforce planning approaches for public health nutrition practice in Canada. Public health dietitians, leaders, and academics must collaborate to recognize and address this need.

Exercise interventions improve quality of life and survival for individuals living with and beyond cancer (ILWBC), yet equitable access remains limited. Evidence on characteristics of who enrolls in exercise oncology programs is scarce, leaving gaps for equity-focused recruitment and scale-up, particularly in rural and underserved settings. The EXercise for Cancer to Enhance Living Well (EXCEL) study offers a unique opportunity to examine these issues across a Canada-wide cohort. EXCEL is an 8-12-week tailored exercise intervention delivered primarily to ILWBC in rural/remote communities, with additional enrollment of urban participants lacking exercise oncology resources. Adults with any cancer type or stage were eligible if pre-treatment, receiving treatment, or within 3 years post-treatment. This analysis describes baseline demographic, lifestyle, medical, and fitness factors by rural versus urban residence using descriptive statistics. Of 1495 participants enrolled in the EXCEL program (rural n = 1085; urban n = 400), baseline characteristics differed modestly by geography. Age did not differ significantly between rural and urban participants. Rural participants were more often male, had lower educational attainment, and demonstrated higher BMI than urban participants. Urban participants exhibited greater ethnic diversity and higher levels of education. Physical activity levels were similar with 78% classified as physically active at baseline. This Canada-wide baseline analysis reveals rural-urban variations in age, treatment status, disease burden, education, and lifestyle, yet comparable physical activity and functional capacity levels. These findings provide descriptive evidence to inform recruitment strategies and considerations for exercise oncology program delivery across geographic settings.

Emergency departments (EDs) have seen growing rates of pediatric mental health presentations, a trend exacerbated by the COVID-19 pandemic. Many of these patients will 'board', remaining in the ED for prolonged periods of time while awaiting transfer to an inpatient bed. Boarding disproportionately impacts mental health patients and is associated with worse patient health outcomes and healthcare system inefficiency. The objective of this scoping review is to synthesize the extent and nature of evidence relating to pediatric mental health boarding, and to identify knowledge gaps. Searches were conducted in MEDLINE, Embase, PsycINFO, and CINAHL for peer-reviewed literature involving mental health patients boarding in hospital EDs. Studies underwent eligibility screening for pediatric populations and data extraction by two reviewers.Results are reported per PRISMA-ScR guidelines. Three thousand four hundred and fifty-eight studies were screened for title and abstract eligibility, 386 of which were assessed at full-text. Twenty-eight studies met inclusion criteria. Of these, 19 assessed variables impacting boarding, 18 quantified boarding duration or prevalence, 6 measured the impacts of boarding, 5 assessed interventions to mitigate boarding, and 4 provided consensus recommendations. Eighty-two percent of studies were published within the last 5years and all are from the United States. Reported mean ED boarding times ranged from 5 to 54h across 5 studies. Of 7 studies assessing the impact of COVID-19 on pediatric mental health boarding, all reported that COVID-19 was associated with increased boarding prevalence and/or duration. An emerging body of literature on the burden and impacts of ED boarding among pediatric mental health patients suggests that boarding is a pressing concern in the delivery of pediatric emergency healthcare that has worsened since COVID-19. This is the most comprehensive evidence synthesis on pediatric mental health boarding to date, highlighting the impacts of boarding and the solutions studied to address this problem.

Triheptanoin is an anaplerotic agent to provide substrates to the TCA cycle. This novel therapy improved neurodevelopmental outcome in our patient with PDE-ALDH7A1. We think that trihepatonoin should be the part of the current standard therapy to improve neurodevelopmental outcomes in patients with PDE-ALDH7A1.

Abstract Background Tissue transglutaminase antibodies (tTG-IgA) are the primary tool for celiac disease (CeD) screening, can be incorporated into a formal diagnosis of CeD without the need for biopsy-confirmation, and are recommended for subsequent monitoring of disease status. However, it remains understudied how frequently children are further tested after an initial positive result. Methods Administrative data from Alberta, Canada were utilized to identify children with their first positive tTG-IgA result between 2016 and 2023. Children were stratified according to baseline result: low (1.0-2.9× the upper limit of normal [ULN]), medium (3.0-9.9× the ULN), and high (≥10× the ULN). Mean cumulative functions were estimated to determine the average number of repeated tTG-IgA tests across time. Further differences were evaluated by sex, age, urban-rural status, and socioeconomic status. Results Among 4405 children with incident CeD autoimmunity, almost half (49.1%) had high baseline values at index positivity. These children also had the most overall and positive follow-up tests, on average. For example, within 5 years, those with baseline tTG-IgA ≥10× the ULN had, on average, 3.7 overall (95% CI, 3.6-3.9) and 2.5 positive (95% CI, 2.4-2.6) repeat tests, respectively, compared to 2.1 overall (95% CI, 2.0-2.2) and 0.8 positive (95% CI, 0.7-0.8) among those with 1.0-2.9× the ULN. Significant differences were also present across the urban-rural spectrum and the socioeconomic gradient (eg, highest in metropolitan centres). Conclusion These findings showcase notable variation in follow-up tTG-IgA testing among children with incident CeD autoimmunity in Alberta, Canada.