Trillium Health Centre

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.

Normothermic regional perfusion (NRP) is a postmortem technique that restores oxygenated blood flow to transplantable organs in situ after death determination in donation after circulatory death to improve organ viability and function. Although observational evidence strongly suggests NRP is superior to conventional rapid organ recovery, it has generated ethical controversy internationally. While much of the debate revolves around NRP's compatibility with the dead donor rule, an unresolved ethical question facing organ procurement organizations is whether, in addition to general consent (or 'authorization') to organ donation, specific consent to NRP should be sought from surrogate decision makers. As NRP practice continues to evolve and as more jurisdictions consider NRP adoption, developing policy governing NRP consent or notification practices should be a priority for organ procurement organizations. In this Personal Viewpoint article, we outline arguments for and against a consent requirement. We conclude that ongoing ethical controversy and unresolved empirical questions concerning the potential for the resumption of intracranial blood flow during NRP support a cautious, consent-based approach at this stage of NRP's adoption.

Knee osteoarthritis (OA) and type 2 diabetes (T2D) commonly coexist, but their combined impact on health-related quality of life (HRQoL) remains understudied. We assessed the association between symptomatic knee OA and HRQoL in individuals with T2D and explored potential explanations. We conducted a secondary analysis of a cross-sectional study of individuals with T2D. Symptomatic knee OA was defined using NICE criteria (age ≥45 years, activity-related knee pain, morning stiffness ≤30 min; no inflammatory arthritis). HRQoL (EQ-VAS, 0-100), sleep disturbance (PROMIS Sleep Disturbance 4a), depressed symptoms (PROMIS Depression 8b), fatigue (PROMIS Fatigue 4a), and walking limitation (Health Assessment Questionnaire) were assessed via questionnaire. Linear regression modeled associations between knee OA and HRQoL, adjusting for age, gender, BMI, education, and comorbidities. The explanatory effects of sleep, mood, and mobility were assessed via further sequential adjustment. We included 341 participants: mean age 66.4 years, 51.9 % female, 29.0 % had knee OA. Participants with T2D and knee OA reported lower HRQoL, greater sleep disturbance, fatigue, depressive symptoms, and walking limitations than those without knee OA. Knee OA was associated with lower HRQoL (β = -11.96; 95 % CI: -16.59 to -7.32) in the unadjusted analysis. Adjustment for confounders partially attenuated this effect (β = -8.33; 95 % CI: -12.72 to -3.94). Further adjustment for sleep, mood, and walking limitations fully attenuated the association. Symptomatic knee OA is strongly associated with impaired HRQoL in T2D, explained by sleep disturbance, low mood, and mobility limitation. Integrated care addressing OA may improve quality of life in this population.

Since the onset of the COVID-19 pandemic, the number of Remote Care Management (RCM) programs in Ontario has increased; however, many have not been objectively evaluated based on their structure and performance. This study demonstrates how the core structure of the RCM model, developed by the Connected Care Halton Ontario Health Team (CCHOHT) with Halton Healthcare Services and Ontario Health atHome, aligns with the RCM recommendations and evaluation tool from the Ontario Ministry of Health (OMH). The focus is specifically on the CCHOHT's RCM program for chronic diseases. This study presents the CCHOHT's RCM model to demonstrate the degree to which it is consistent with the recommendations for developing RCM programs forwarded by the OMH. It also evaluates the CCHOHT's current chronic diseases RCM program using the OMH's RCM evaluation taxonomy tool and an amended version of this tool proposed by the authors. The taxonomy is based on four foundational criteria: technology, touch, integration and equity. The CCHOHT's chronic diseases RCM program meets the OMH's four RCM taxonomy criteria. The program is a digital solution that remotely manages patients, provides follow-up communication, and escalates critical cases through a more patient-centred, connected clinical pathway of services and care partners. The CCHOHT's RCM model and its chronic diseases RCM program are built on intersecting principles of RCM and integrated care as articulated by the OMH. The adaptable nature of the RCM model allows it to be extended to other clinical conditions.

To present the results of a systematic review evaluating the utility of accessible and removable offloading footwear for diabetic foot ulcer (DFU) prevention, healing, and recurrence. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin, wound, and diabetic foot care. After completing this continuing education activity, the participant will: Summarize the evidence the authors considered when evaluating the use of offloading footwear for DFUs.Identify the characteristics of the patients and clinical environments in which offloading devices were used.Illicit the results of the authors' study detailing the utility of basic offloading footwear for prevention, healing, and recurrence of DFUs.Elucidate the authors' conclusions about the efficacy and safety of basic offloading footwear for high-risk diabetic foot, active ulcers, and recurrent ulcer risk.

ObjectiveTo evaluate the effects of liberal transfusion strategy (trigger haemoglobin ≤90–100 g/L) compared with a restrictive strategy (trigger haemoglobin ≤70–80 g/L) on long-term neurological functional outcome in anaemic adult patients with acute acquired brain injury (ABI).DesignSystematic review and study-level meta-analysis of randomised controlled trials (RCTs).Data sourcesMEDLINE, EMBASE, Cochrane from inception to 6 February 2025.Study selectionRCTs enrolling patients with acute ABI and anaemia (haemoglobin ≤100 g/L), comparing a liberal vs restrictive transfusion strategy.Data extraction and synthesisTwo reviewers independently identified eligible studies, extracted data and assessed risk of bias. We performed random-effects meta-analysis of RCTs and applied Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the certainty of evidence. Our primary outcome was an unfavourable neurological functional outcome, using the Glasgow Outcome or modified Rankin scales.ResultsFive trials enrolling 2364 patients with acute ABI and anaemia were included in the primary analysis. Liberal transfusion reduces the risk of unfavourable neurological outcome (risk ratio (RR)=0.89, 95% CI 0.84 to 0.95, high certainty). Liberal transfusion may reduce severe disability (RR=0.82, 95% CI 0.66 to 1.02, moderate certainty), and increase good recovery compared with restrictive transfusion (RR=1.29, 95% CI 0.95 to 1.76, low certainty). We found no difference in the risk of most adverse events, including death. Statistical heterogeneity was low (I2=0%–36%) for neurological outcomes.ConclusionsIn adults with acute ABI and anaemia, liberal transfusion reduces the risk of unfavourable outcome (high certainty) and possibly improves the chances of good recovery (low certainty) when compared with restrictive transfusion.PROSPERO registration numberCRD42025628732.