Lakeridge Health

To identify factors associated with short-term mortality among patients receiving microaxial flow pump (mAFP) therapy for acute myocardial infarction-related cardiogenic shock (AMI-CS). We searched four databases (MEDLINE, Embase, CENTRAL, and Scopus) from January 1, 2004, to January 1, 2025. We selected English-language studies that included adults with AMI-CS receiving mAFP and evaluated factors associated with short-term mortality. We excluded patients receiving concurrent venoarterial extracorporeal membrane oxygenation, as well as studies that solely included patients presenting with out-of-hospital cardiac arrest. Two authors performed citation screening and data extraction. For each factor evaluated in at least two studies, we performed meta-analyses of adjusted odds ratios (aORs) using a random-effects model. Risk of bias was evaluated using the Quality in Prognosis Studies tool, and the certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations methodology. Our primary analysis included 18 studies, encompassing 20,617 patients. Median short-term mortality across studies was 50.7% (interquartile range 38.4-55.3%). Factors associated with short-term mortality based on high-certainty evidence included: increased age (aOR, 1.04 per year [95% CI, 1.03-1.05 per year] or ≥ 65 yr (aOR, 2.42 yr [95% CI, 0.77-7.64 yr]), female sex (aOR, 1.26 [95% CI, 1.09-1.45]), higher body mass index (aOR, 1.05 per point [95% CI, 1.04-1.07 per point]), higher heart rate (aOR, 1.02 per beats/min [95% CI, 1.01-1.02 per beats/min]), higher serum creatinine (aOR, 1.35 per mg/dL [95% CI, 1.08-1.70 per mg/dL]), mechanical ventilation (aOR, 2.53 [95% CI, 1.82-3.53]), vasopressors (aOR, 1.52 [95% CI, 1.11-2.08] for any vasopressors and aOR, 1.37 [95% CI, 1.18-1.58] per each vasopressor), presentation with ST-elevation myocardial infarction (aOR, 1.59 [95% CI, 1.11-2.26]), cardiac arrest (aOR, 2.85 [95% CI, 2.22-3.64]), and hypoxic-ischemic brain injury (aOR, 5.36 [95% CI, 3.03-9.47]). We identified several prognostic factors associated with short-term mortality in AMI-CS patients receiving mAFP support. This work may help inform clinicians, patients, and families regarding utilization of mAFP in AMI-CS.

To assess the effectiveness of self-help interventions in reducing work disability and improving work- and health-related outcomes among individuals with musculoskeletal, anxiety, and/or depressive conditions; to explore lived experiences with self-help interventions; and to integrate quantitative and qualitative findings to guide future research and implementation. We conducted a rapid mixed methods systematic review following World Health Organization (WHO) and Cochrane Rapid Reviews Methods Group guidance. We included randomized controlled trials (RCTs), quasi-experimental, qualitative, and mixed methods studies published in English since 2007. Eligible studies evaluated self-help interventions targeting musculoskeletal, anxiety, and/or depressive conditions in working-age adults (18-65years). Quantitative outcomes included functioning, return-to-work, productivity, and self-efficacy; qualitative outcomes reflected user experiences. Risk of bias was assessed using RoB 2, ROBINS-I, and CASP tools. Findings were synthesized narratively by intervention types and outcome domain. Eight studies met inclusion criteria: five RCTs, two quasi-experimental, and one qualitative. All seven quantitative studies were rated high risk of bias. Short-term improvements were observed in disability and physical quality of life in two exercise-based trials, but effects on work participation were inconsistent and generally below thresholds for clinical importance. Cognitive-behavioral and psychoeducational programs produced small improvements in self-efficacy and presenteeism, and relaxation and educational interventions showed no meaningful effects. The qualitative study highlighted workplace barriers such as productivity pressures and limited opportunities for movement that constrained engagement. Self-help interventions may modestly improve self-management, disability, and coping in the short term but show limited and inconsistent evidence for reducing work disability. Their effectiveness likely depends on adherence, contextual support, and integration into workplace environments. Future high-quality, co-designed, context-sensitive studies are needed to clarify effectiveness, safety, and sustainability in real-world settings. PROSPERO registration: CRD42023472934, registered on October 16, 2023; modified March 17 2025.

Maternal heart rate artifact occurs during fetal heart rate monitoring when the maternal heart rate is mistaken for the fetal heart rate. Unrecognized maternal heart rate artifact poses major patient safety risks due to errors of commission and omission when healthcare teams do not realise that the supposedly "fetal" heart rate tracing that they are observing is misleading. In 2022, a technical update was published by the Society of Obstetricians and Gynaecologists of Canada to mitigate this risk by describing the signs of possible maternal heart rate artifact and the steps to obtain an accurate fetal heart rate tracing. Despite this, concerns remain regarding implementation in clinical practice. Here, we present 2 illustrative fetal and maternal heart rate tracings to increase awareness and help with knowledge translation.

Suboptimal blood volume collection negatively affects pathogen recovery and time to pathogen detection in clinical blood culture samples. This study evaluated the performance of the ultrathin-wall cannula device of the BD Vacutainer UltraTouch Push Button Blood Collection Set (UltraTouch; BD Life Sciences, Franklin Lakes, NJ) in increasing the blood volume collected compared to regular cannulas. In this retrospective study, the volume of blood collected in negative BD BACTEC Plus Aerobic/F Culture Vials prior to and following blind conversion to UltraTouch was measured from blood background metabolic activity signal acquired during the initial incubation period in the BD BACTEC FX instrument using a custom software application (patent pending). Differences in average fill volume between pre- and post-conversion were evaluated overall and by month. A separate logistic regression was also performed to model the relationship between monthly average blood volume increase (mL) and sample positivity rate. Prevalence rates for identified organisms were also assessed. The blood fill volume of 13,356 pre-conversion and 119,971 post-conversion bottles was compared. The average post-conversion fill volume was significantly higher than that of pre-conversion (7.56 mL [95% CI, 7.54-7.59] vs. 5.68 mL [95% CI, 5.62-5.74], respectively). This 1.88 mL increase in collected blood volume increased sample positivity from 7.0% to 7.7% (P = 0.002; odds ratio [OR], 1.11; 95% CI, 1.04-1.19). This study demonstrated that using an ultrathin-wall cannula blood collection device can significantly increase blood culture volume and sample positivity, supporting improved identification of patients suffering from bloodstream infections.IMPORTANCESubstandard blood fill volume practices in clinical settings negatively affect pathogen recovery which, in turn, may impact patients' care. Whereas professional education regarding the importance of adhering to clinical guidelines has been helpful in partly remediating the issue, the role of blood collection set technologies in optimizing blood culture volume has not been studied as thoroughly. Our study assessed the performance of the BD Vacutainer UltraTouch Push Button Blood Collection Set, which is designed with an ultrathin-wall cannula, to improve blood culture volume.

Blunt cerebrovascular injury (BCVI) is a nonpenetrating carotid and/or vertebral artery injury following trauma. Treatment typically involves antiplatelets or anticoagulation followed by repeat imaging. However, little is known regarding the natural history of BCVI on treatment. Therefore, we performed a systematic review and meta-analysis to summarize the healing rates at various intervals of repeat imaging. We searched Embase and Medline from inception to November 22, 2024. We included studies reporting imaging-based follow-up outcomes of adult patients with BCVI. We organized data based on injury status and summarized overall resolution, progression, stability, and worsening of BCVI at various time points and according to injury grade. We included 20 studies involving 2,641 patients. Studies were predominantly retrospective in nature, originating from North America, and follow-up was primarily performed using computed tomography angiography. The median (Q1 to Q3) stroke incidence was 8.5% (5.1% to 13.1%). We demonstrate that lower-grade injury is associated with BCVI healing at follow-up imaging (pooled unadjusted odds ratio, 6.73; 95% confidence interval, 4.23-10.71, moderate certainty). In addition, we demonstrate that Grades I and II injuries demonstrated higher rates of resolution or improvement at every follow-up imaging period. This review demonstrates with moderate certainty that lower-grade BCVIs probably heal faster, while higher-grade BCVIs persist longer. These findings emphasize the importance of considering injury grade when determining the appropriate follow-up imaging interval. Systematic Review and Meta-analysis; Level IV.

Alzheimer’s Disease (AD) is a global issue, with increasing incidence and prevalence as the world’s population ages and life expectancy increases. Projections indicate that by 2050, over 150 million individuals worldwide will be personally living with AD, an impending crisis made worse by the absence of cure therapies. Moreover, the risk factor relationship of dementia with rising global temperatures and air pollution further necessitates the urgency of a coordinated international response. With an extensive economic and emotional burden, AD is no longer just a disease; it is a worldwide societal crisis. This review presents five calls to action to address the AD global health emergency. First, AD research must be approached as an internationally performed activity, involving standardized data sharing, collaborative innovation, and improved access to pharmaceutical studies in low- and middle-income countries (LMICs), alongside increased diversity, inclusion, and equity in research. Second, there must be a commitment to develop universally accessible, affordable, and non-invasive diagnostic tools for AD. Third, advancements in AD therapeutics should prioritize the development of affordable agents, allowing for widespread geographic distribution. Fourth, we identify focus areas for global dementia risk reduction: sleep, head injury prevention, exercise, learning, and diet (SHIELD risk reduction strategy). Fifth, improving care for individuals with AD requires eliminating stigma through educational programs for both the public and caregivers. The escalating AD crisis demands an unprecedented global coalition in research, diagnostics, therapeutics, prevention, and education to avoid a future where the disease becomes the defining crisis of our era.