Joseph Brant Hospital

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.

BackgroundOlder adults living with HIV face challenges accessing regular geriatric care, and while virtual care services could offer a solution, they may come with limitations.ObjectiveThis study aimed to co-design a culturally appropriate virtual care model tailored to older adults’ needs using the experience-based co-design methodology.MethodsWe used a qualitative, experience-based co-design approach with 19 older adults living with HIV. The process involved 3 phases: identifying needs through interviews and questionnaires, codeveloping a care model prototype through focus groups and a workshop, and refining the model using feedback from a world café format. Data were analyzed using thematic content analysis.ResultsThe co-design process led to a virtual care model prototype that directly addressed participants’ key needs. These included personalized communication methods, simplified technology interfaces for easier access, and culturally responsive care practices. Participants emphasized the importance of privacy in virtual consultations, flexible scheduling to accommodate health fluctuations, and ongoing support for managing both HIV and aging-related conditions. Their feedback shaped a model designed to bridge service gaps, offering a more inclusive, accessible, and patient-centered approach to virtual geriatric care.ConclusionsThis study co-designed a potential virtual geriatric care model grounded in the experiences of older adults living with HIV. By integrating participants’ insights throughout the design process, the model offers a promising approach to improving care for this vulnerable population. Future directions for research to test this model are proposed.

To the Editor, Healthcare-associated infections (HAI) are the most frequently reported adverse event in healthcare worldwide. 1 In Ontario and Quebec, Canada, C. difficile (CDI) and methicillin-resistant S. aureus (MRSA) HAI surveillance are mandatory for acute care hospitals. 2, 3 Traditional active surveillance by infection prevention and control (IPC) teams is considered the "gold-standard" but is time-consuming and labor-intensive. 3 However, passive surveillance using administrative data would be a cost-effective alternative as it relies on routinely collected and consistently defined data. 4 The Canadian Institute for Health Information (CIHI) implemented HAI surveillance through its Discharge Abstract Database (DAD), an administrative database that contains a codified summary of a patients' stay in hospital, which is coded by the hospital clinical coding team (CCT) using the International Classification of Diseases 10th Revision (ICD-10) codes, in accordance with CIHI standards. 5 However, it has been demonstrated that its accuracy in Canada is limited in comparison with active surveillance data. 6 Since 2016, the CCT at St. Joseph's Healthcare Hamilton (SJHH), Ontario, has used IPC data to report CDI and MRSA infections to CIHI. To do so, IPC sent a monthly HAI list to the CCT, ensuring alignment and provided training on the differences and definitions used for these infections. This practice deviates from CIHI standards, which mandate that coders only use chart documentation from physicians, midwives, or nurse practitioners. In 2017, SJHH transitioned to an electronic medical record (EMR), allowing IPC team to document infections directly, eliminating the need for monthly lists. A report was developed to support monthly and year-end reconciliation, enhancing data accuracy. The collaborative approach was readily adopted, resolving data discrepancies. As a quality assessment project approved by the Director of professional Services, we conducted a study to assess the validity of

To review a practical and scientifically sound application of the wound bed preparation model for communities without ideal resources. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. After participating in this educational activity, the participant will:1. Summarize issues related to wound assessment.2. Identify a class of drugs for the treatment of type II diabetes mellitus that has been shown to improve glycemia, nephroprotection, and cardiovascular outcomes.3. Synthesize strategies for wound management, including treatment in resource-limited settings.4. Specify the target time for edge advancement in chronic, healable wounds.

In response to the global rise in chronic diseases among aging populations, healthcare systems are transitioning from acute care models to community‐based interventions tailored to the diverse needs of older adults. This study aimed to explore the role of champions in implementing community‐based interventions for older adults with chronic conditions to address the gap in understanding the specific functions and impact of champions in these contexts. A scoping review methodology used a six‐stage process aligned with the Arksey and O’Malley framework. After searching across 8 databases, a total of 10 studies met all inclusion criteria. The included studies were predominantly from the United States (n = 6/10, 60%) and the United Kingdom (n = 2/10, 20%). Most studies employed quantitative methodologies (n = 6/10, 60%), describing and evaluating healthcare champion programs or investigating the quality of care for older adults. Community interventions targeted various chronic conditions (e.g., dementia) and health outcomes (e.g., medication reconciliation). Champions, ranging from 17 to 106 individuals, played diverse roles as professional healthcare providers or lay volunteers. They facilitated intervention delivery, advocated for change, participated in evaluation, and fostered collaboration within multidisciplinary teams, contributing significantly to program implementation and health information dissemination. Recognizing champions’ diverse roles, researchers and practitioners can tailor interventions to leverage their strengths and maximize their impact. Additionally, the review highlights the importance of clear definitions and operationalization of champions to ensure consistency across studies and interventions. Practitioners can use this knowledge to identify, train effectively, and support champions within their communities, ultimately enhancing the sustainability and success of interventions for older adults with chronic conditions.

Computed tomography (CT) findings of acute and chronic ischemia are associated with subsequent stroke risk in patients with transient ischemic attack. We sought to validate these associations in a large prospective cohort of patients with transient ischemic attack or minor stroke. This prospective cohort study enrolled emergency department patients from 13 hospitals with transient ischemic attack who had CT imaging. Primary outcome was stroke within 90 days. Secondary outcomes were stroke within 2 or 7 days. CT findings were abstracted from radiology reports and classified for the presence of acute ischemia, chronic ischemia, or microangiopathy. Multivariable logistic regression was used to test associations with primary and secondary end points. From 8670 prospectively enrolled patients between May 2010 and May 2017, 8382 had a CT within 24 hours. From this total population, 4547 (54%) patients had evidence of acute ischemia, chronic ischemia, or microangiopathy on CT, of whom 175 had a subsequent stroke within 90 days (3.8% subsequent stroke rate; adjusted odds ratio [aOR], 2.33 [95% CI, 1.62-3.36]). This was in comparison to those with CT imaging without ischemia. Findings associated with an increased risk of stroke at 90 days were isolated acute ischemia (6.0%; aOR, 2.42 [95% CI, 1.03-5.66]), acute ischemia with microangiopathy (10.7%; aOR, 3.34 [95% CI, 1.57-7.14]), chronic ischemia with microangiopathy (5.2%; aOR, 1.83 [95% CI, 1.34-2.50]), and acute ischemia with chronic ischemia and microangiopathy (10.9%; aOR, 3.49 [95% CI, 1.54-7.91]). Acute ischemia with chronic ischemia and microangiopathy were most strongly associated with subsequent stroke within 2 days (aOR, 4.36 [95% CI, 1.31-14.54]) and 7 days (aOR, 4.50 [95% CI, 1.73-11.69]). In patients with transient ischemic attack or minor stroke, CT evidence of acute ischemia with chronic ischemia or microangiopathy significantly increases the risk of subsequent stroke within 90 days of index visit. The combination of all 3 findings results in the greatest early risk.

BackgroundDance is a mind-body activity of purposeful rhythmic movement to music. There is growing interest in using dance as a form of cognitive and physical rehabilitation. This manuscript describes the development of GERAS DANcing for Cognition and Exercise (DANCE) and evaluates its feasibility in older adults with cognitive and mobility impairments.MethodsThe progressive dance curricula were delivered for 15 weeks (1-h class; twice weekly). Participants were eligible if they were community-dwelling older adults aged 60+ with early cognitive or mobility impairment able to follow three-step commands and move independently. Feasibility outcomes included recruitment/retention, adherence, participant satisfaction, safety, and adverse events.ResultsTwenty-five older adults (mean (standard deviation [SD]) age = 77.55 (6.10) years, range 68–90 years) with early cognitive (Montreal Cognitive Assessment score (SD) = 21.77 (4.05)) and mobility (92% were pre-frail/frail as indicated on the Fried Frailty Phenotype) impairments were recruited from a geriatric out-patient clinic or within the community. A total of 20/25 (80%) participants completed the study. Average class attendance was 72%, and self-reported homework adherence “most-days / every day” was 89%. A stepwise progression in the dance curricula was observed with increases in motor complexity and balance demands, and 95% of participants rated the program as a “just-right” challenge. Ninety percent of participants rated GERAS DANCE as excellent, and 100% would recommend the program to a friend or family member. Over 50% of participants connected outside of class time for a self-initiated coffee club. Adverse events of falls and fractures were reported for 2 participants, which occurred at home unrelated to the dance intervention during the study period. Pre-determined thresholds for feasibility were met for all outcomes.DiscussionGERAS DANCE is a feasible and enjoyable program for older adults with early cognitive or mobility impairments. GERAS DANCE curriculum grading (duration; sequence; instructions) and motor complexity increases in agility, balance, and coordination appear appropriately tailored for this population. Future work will explore the feasibility of GERAS DANCE in new settings (i.e., virtually online, community centers, or retirement homes) and the mind-body-social benefits of dance.