Royal Jubilee Hospital

Introduction: Patient and family centered care (PFCC) is a foundational value of the Saskatchewan Health Authority. Since 2016, Regina ICUs have adopted an open family presence model and encouraged participation in multidisciplinary rounds. However, a prior study suggested that over half of patients and families felt uninvolved in key decisions. This study evaluated ICU stakeholders’ experiences with family rounds and PFCC to identify opportunities to improve structure, timing, and delivery of care. Methods: A qualitative study was conducted in the adult ICUs at Regina General and Pasqua Hospitals. Participants included patients admitted ≥48 hours, family members who attended ≥1 multidisciplinary round, and ICU healthcare providers (nurses, physicians, pharmacists, allied health). Exclusions were inability to provide informed consent and lack of English fluency without interpreter support. Purposive sampling was used. Semi-structured interviews (June 13–July 23, 2025) were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis (NVivo 15). Results: Nine participants: patients (n=2, 22%), family (n=3, 33%), healthcare providers (n=4, 44%). Median age was 44 years (IQR 35–62.5); 56% female. Patients’ median age was 58 (IQR 48–68), family 44 (IQR 41–71), providers 35 (IQR 30–47). Education: 4 doctoral, 2 undergraduate, 2 high school, 1 grade 10. Occupations included ICU physicians (n=3), pharmacist (n=1), and various non-clinical roles. Four themes emerged: (1) Communication gaps/role clarity (78%); (2) Emotional landscape/psychological strain (67%); (3) Inclusion and structure of rounds (56%); (4) Systemic/environmental challenges (56%). Patients stressed emotional vulnerability and reliance on nurses; families felt excluded and unaware of rounding practices; providers cited operational barriers to PFCC consistency. Conclusions: While PFCC was valued, gaps in clarity, communication, and inclusion were identified. Suggested co-designed interventions include standardized rounding checklists, plain language care summaries, and consistent scheduling/notification of rounds to promote transparency, enhance emotional support, and ensure consistent ICU communication processes.

The safety, yield, and prognosis of a type 1 procainamide-induced Brugada pattern are incompletely understood and may differ from those of other sodium channel blockers with greater potencies. The safety of procainamide infusion and yield of a type 1 Brugada pattern were assessed according to indication in consecutive patients from the Canadian Hearts in Rhythm Organization registry. Outcomes were evaluated in patients with a standard or high-lead procainamide-induced Brugada pattern (without previous cardiac arrest) and compared with those with a spontaneous type 1 pattern. In 947 consecutive patients undergoing procainamide infusion for the diagnosis or exclusion of Brugada syndrome, 2 patients (0.2%) experienced asymptomatic ventricular arrhythmias related to procainamide, which resolved upon discontinuation of the infusion. The yield of a type 1 pattern was 7.2% in 390 patients with unexplained cardiac arrest, 22.2% in 135 patients with a family history of Brugada syndrome, and 6.9% in 116 patients with a family history of unexplained cardiac arrest or sudden death. Test yield was 46.6% in 189 patients with a non-specific type 2 or 3 Brugada pattern and 92% in those with an intermittent spontaneous type 1 pattern (ie, implied sensitivity of 92%). Estimated specificity was very high. In 137 patients with a procainamide-induced type 1 Brugada pattern (with no previous cardiac arrest) followed for a mean of 5.9±4.5 years, no patients met the primary composite arrhythmic end point (0%). In 105 spontaneous type 1 patients, one patient (1%) met the primary end point after receiving appropriate shocks for ventricular fibrillation. Thirteen percent had a primary prevention implantable cardioverter defibrillator implanted at baseline (one appropriate shock), with an additional 7% undergoing implantable cardioverter defibrillator implantation during follow-up, predominantly for syncope with a suspected arrhythmic mechanism. No patient who underwent implantable cardioverter defibrillator implantation during follow-up subsequently received appropriate therapy. Procainamide infusion is extremely safe for the diagnosis and exclusion of Brugada syndrome, with yield dependent on pretest probability and indication for testing. Estimated sensitivity and specificity appear to be high. Patients with an asymptomatic procainamide-induced type 1 Brugada pattern are at very low risk of malignant ventricular arrhythmias.

Lymphomatoid papulosis (LyP) has several histopathologic presentations. LyP featuring gamma-delta (γδ) T-cell receptor expression may masquerade as and may be misdiagnosed as aggressive cutaneous T-cell lymphoma, particularly primary cutaneous γδ T-cell lymphoma (PCGDTL) or γδ mycosis fungoides. We performed a clinicopathologic analysis of the largest series of LyP featuring γδ T-cell expression. We identified 26 patients with a diagnosis of LyP with γδ T cells from our institutions, as well as through a comprehensive review of the literature, and characterized these cases. Most cases were treated with topical steroids or not treated at all. The majority of cases showed a CD4 - CD8 + phenotype and featured at least one cytotoxic marker. Histopathologic features included an intraepidermal or dermal infiltrate with large cells and frequent angiotropism. One case was initially misdiagnosed as PCGDTL, requiring further therapy. Our case series, the largest international cohort of γδ T cell predominant LyP cases, confirms marked clinicopathologic heterogeneity that may contribute to misdiagnosis, reasserting the need to identify classic clinical features, CD30 + T-cell components, and markers of cytotoxicity when dealing with this differential diagnosis. A limitation of this study includes somewhat limited follow-up, histologic, and immunophenotypic information for some cases.

Ionizing radiation has become widely used in medicine, with application in diagnostic techniques, such as computed tomography (CT) and radiation therapy (RT), where X-rays are used to diagnose and treat tumors. The X-rays used in CT and, in particular, in RT can have harmful side effects; hence, an accurate determination of the delivered radiation dose is of utmost importance to minimize any damage to healthy tissues. For this, medical specialists mostly rely on theoretical predictions of the delivered dose or external measurements of the dose. To extend the practical use of ionizing radiation-based medical techniques, such as magnetic resonance imaging (MRI)-guided RT, a more precise measurement of the internal radiation dose internally is required. In this work, a novel approach is presented to measure dose in liquids for potential future in vivo applications. The strategy relies on MRI contrast agents (CAs) that provide a dose-sensitive signal. The demonstrated materials are (citrate-capped) CaF2 nanoparticles (NPs) doped with Eu3+ or Fe2+/Fe3+ ions. Free electrons generated by ionizing radiation allow the reduction of Eu3+, which produces a very small contrast in MRI, to Eu2+, which induces a strong contrast. Oxidative species generated by high-energy X-rays can be measured indirectly using Fe2+ because it oxidizes to Fe3+, increasing the contrast in MRI. Notably, in the results, a strong increase in the proton relaxation rates is observed for the Eu3+-doped NPs at 40 kV. At 6 MV, a significant increase in proton relaxation rates is observed using CaF2 NPs doped with Fe2+/Fe3+ after irradiation. The presented concept shows great promise for use in the clinic to measure in vivo local ionizing radiation dose, as these CAs can be intravenously injected in a saline solution.

Abstract Background Angiosarcomas are aggressive tumors of the vascular endothelium that represent less than 3% of all sarcomas. Epithelioid angiosarcomas are a distinct subtype, and in exceedingly rare circumstances can involve the gastrointestinal tract leading to significant bleeding. Aims Report a case of metastatic epithelioid angiosarcoma as a cause of recurrent gastrointestinal bleeding and the utility of endoscopy in obtaining a diagnosis. Methods A retrospective case report. Results A 71 year old female with a history of type two diabetes and coronary artery disease presented to a peripheral hospital with a two week history of fatigue, abdominal pain, and intermittent fevers for which she was diagnosed with pyelonephritis. Computed tomography (CT) scan of the abdomen/pelvis was unremarkable on admission. Her stay was complicated by cardiac ischemia prompting the initiation of dual antiplatelet therapy and anticoagulation. After a few days she developed melena and an acute hemoglobin drop requiring red blood cell (RBC) transfusion. Gastroscopy revealed a few superficial erosions in the stomach and duodenum. She went on to develop hypercalcemia prompting a repeat CT abdomen/pelvis which showed multiple lytic bone lesions, innumerable small lung nodules, and areas of hypoattenuation in the liver. Contrast enhanced MRI abdomen was performed to better assess the liver, showing a geographic area of signal abnormality without mass like features. The patient was transferred to a tertiary centre for ongoing work-up and management. Shortly after arrival, a bone biopsy from a lytic lesion of the iliac crest was taken. Initial histopathology was inconclusive for malignancy. During this time, she had ongoing melena and need for intermittent RBC transfusions. Enteroscopy revealed multiple centrally ulcerated, hemorrhagic, erythematous/purpuric lesions throughout the stomach and proximal small bowel (Figure 1a). A duodenal lesion with fresh clot was clipped and multiple biopsies were taken from the stomach and duodenum. Histopathology from a gastric biopsy confirmed the diagnosis of epithelioid angiosarcoma (Figure 1b). PET scan revealed uptake in bone, lungs, and liver. The patient received 1 cycle of palliative chemoradiation, however this was discontinued due to frailty. Overt bleeding and intermittent RBC transfusions continued. The patient was transferred to full comfort care and died within 4 months of initial presentation to hospital. Conclusions Epithelioid angiosarcoma involving the gastrointestinal tract should be considered as a cause for upper gastrointestinal bleeding. Our case highlights the endoscopic characteristics and the importance of endoscopic biopsy in obtaining a histopathologic diagnosis. Figure 1a. Enteroscopy showing metastatic angiosarcoma to the stomach and small bowel. A. Gastroesophageal junction; B. Cardia and fundus; C. Duodenal bulb; D. Second portion of duodenum. Figure 1b. Metastatic epithelioid angiosarcoma to the stomach. A-B. Low and medium power H&E; C. Cytokeratin AE1/3; D. Ber-EP4; E. CD31; F. ERG. Funding Agencies None

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Epicardial pulsed field ablation (PFA) of ganglionated plexi (GPs) is being explored as a potential treatment for atrial fibrillation. Initial work using open-chest access with a monopolar ablation device has been completed. This study describes the early development work for a device that can be used with subxiphoid access and deliver bipolar ablation pulses. Electric field computational models have been used for the initial guidance on pulse parameters. An in vivo assessment of these ablation parameters has been performed in an open-chest canine study, while subxiphoid access and navigation of the device has been demonstrated in a porcine model. Results from this acute study have demonstrated the promising potential of this approach.

A 78 year old lady sought medical attention for palpitations with documented regular wide complex tachycardia with a left bundle branch block (figure [1](#fig-cap-0001)) as well as atrial fibrillation. She presented for a catheter ablation for atrial fibrillation and presumed CTI-dependent atrial flutter. As a part of the procedure, we performed an electrophysiology study. We performed pacing manoeuvres to evaluate for the presence of a concealed accessory pathway. She had an underlying left bundle branch block observed in sinus rhythm. Results of para-Hisian pacing maneuver are displayed in figure [2](#fig-cap-0002) with intracardiac electrograms and corresponding 12-lead ECG. Para-Hisian pacing is performed at a constant pacing interval through the distal electrode of the His bundle catheter. There is a decapolar catheter in the coronary sinus with the proximal electrode positioned at the Os. Here are some questions to consider: There are 4 different paced morphologies observed. What does each one of these represent? How can we interpret the findings of this maneuver? What role does pre-existing left bundle branch block play in our interpretation?