Thunder Bay Regional Health Sciences Centre is an acute care facility serving Thunder Bay and much of Northwestern Ontario, Canada. The hospital has 395 acute care beds. All of its patient rooms are handicapped accessible and the facility is air-conditioned with "negative pressure" rooms to accommodate those who may be suffering from communicable diseases. The TBRHSC is a leader in providing cancer care. The hospital is supported by the Thunder Bay Regional Health Sciences Foundation.Thunder Bay Regional Health Sciences Centre's emergency department is one of the busiest in Canada, receiving over 106,000 annual visits.
Importance:The age-adjusted D-dimer cutoff (age × 10 µg/L in patients 50 years or older), safely increases the diagnostic yield of D-dimer in patients with suspected pulmonary embolism but has not been validated in patients with suspected leg deep vein thrombosis (DVT). Objective:To prospectively validate whether using an age-adjusted D-dimer cutoff allows clinicians to safely rule out DVT. Design, Setting, and Patients:Multicenter, multinational prospective management outcome study conducted in 27 centers in Belgium, Canada, France, and Switzerland between January 2015 and October 2022 (last follow-up visit, January 30, 2023) and including outpatients presenting to the emergency department with suspected DVT. Interventions:Patients were assessed by a sequential diagnostic strategy based on the assessment of clinical pretest probability by the Wells score, a highly sensitive D-dimer test, and leg compression ultrasonography. Patients in whom DVT was ruled out were followed up for a 3-month period. Main Outcome and Measure:The primary outcome was the rate of adjudicated symptomatic venous thromboembolic events during follow-up in patients in whom DVT was ruled out based on a D-dimer value between the conventional cutoff of 500 µg/L and their age-adjusted cutoff. Results:A total of 3205 patients were included. Median age was 59 years, and 1737 (54%) were female. DVT prevalence was 14%. Among the 2169 patients with a non-high or unlikely clinical probability, 531 (24.5% [95% CI, 22.7%-26.4%]) had a D-dimer level less than 500 µg/L, and 161 additional patients (7.4% [95% CI, 6.4%-8.6%]) had a D-dimer level between 500 µg/L and their age-adjusted cutoff. No failures were identified in patients with a D-dimer level 500 µg/L or greater but below the age-adjusted cutoff (0% [95% CI, 0%-2.3%]). Among patients 75 years or older, using the age-adjusted cutoff instead of the 500-µg/L cutoff increased the proportion of negative D-dimer from 33 of 379 (8.7% [95% CI, 6.3%-12.0%]) to 99 of 379 (26.1% [95% CI, 22.0%-30.8%]), without any false-negative test results. Conclusions and Relevance:The age-adjusted D-dimer cutoff may safely rule out DVT and was associated with a larger number of patients in whom DVT could be effectively ruled out. Trial Registration:ClinicalTrials.gov Identifier: NCT02384135.
Background: Pulmonary blastomycosis is a lung infection caused by thermally dimorphic fungi Blastomyces spp [...]
Aim: This scoping review aimed to map and describe the existing literature on nurses’ attitudes toward hospitalized patients who use substances (PWUS). Design: A scoping review was conducted in accordance with Joanna Briggs Institute (JBI) methodology and reported using the PRISMA-ScR guidelines. Methods: A systematic search was conducted on August 27, 2024, in PubMed, PsycINFO, and CINAHL to identify peer-reviewed studies published in English, between 2014 and 2024. Eligible studies included original qualitative and quantitative research examining nurses’ attitudes toward PWUS in hospital settings. Two independent reviewers conducted study selection using a structured screening process. Data were extracted using an author-developed tool capturing study characteristics, including country of origin, aims, methodologies, nursing context, hospital setting, approaches to assessing attitudes, and key findings. Extracted data were synthesized descriptively to map study characteristics, conceptual patterns, and thematic emphases within the literature. Of 1568 abstracts screened, 13 studies met inclusion criteria, with four additional studies identified through citation mining, resulting in 17 included articles. Results: The included literature predominantly described negative attitudes toward PWUS among nurses in hospital settings, alongside recurring thematic emphases related to substance use knowledge and education, challenges in pain management, and perceptions of limited organizational support. Studies varied widely in design, measurement approaches, and geographic context. Findings were organized using Bronfenbrenner’s socioecological model to illustrate how nurses’ attitudes have been examined across individual, interpersonal, organizational, and societal levels, with most studies concentrated at the micro- and mesolevels. Conclusion: This scoping review maps a growing but methodologically heterogeneous body of literature examining nurses’ attitudes toward PWUS in hospital care. The findings highlight conceptual, methodological, and contextual gaps in the existing evidence, particularly related to organizational and macrolevel influences. These gaps highlight important directions for future research aimed at advancing a more comprehensive understanding of nurses’ attitudes within hospital-based substance use care.
Background: Adjuvant pembrolizumab improves disease-free survival in resected stage IB–IIIA non-small-cell lung cancer (NSCLC); however, immune-related pneumonitis remains a clinically significant toxicity [...]
Purpose of review: Cardiovascular disease (CVD) accounts for nearly half of deaths among people receiving maintenance hemodialysis. Observational and interventional data suggest that higher serum magnesium, achieved through higher dialysate magnesium concentrations or oral supplementation, may improve cardiovascular outcomes and survival. This review synthesizes current evidence and provides context for an ongoing cluster-randomized trial that is testing whether a center-wide dialysate magnesium concentration of 0.75 mmol/L, versus ≤0.50 mmol/L, delivered as a policy and sustained for up to four years, reduces the risk of major cardiovascular-related hospitalizations. Sources of information: Peer-reviewed articles. Methods: We searched MEDLINE and EMBASE for observational and interventional studies evaluating serum or dialysate magnesium concentrations and cardiovascular outcomes in patients with chronic kidney disease and/or kidney failure. We appraised the methodological quality of interventional trials. This review is divided into four sections: (1) epidemiological associations between serum magnesium concentrations and CVD outcomes, (2) the impact of a higher concentration of dialysate magnesium on CVD outcomes, (3) the impact of oral magnesium supplementation on CVD outcomes, and (4) ongoing trials. Key findings: Twenty studies, including 10 randomized controlled trials, were reviewed. Systematic reviews and meta-analyses show that hypomagnesemia is associated with higher risks of cardiovascular events and all-cause mortality in hemodialysis. Interventional studies indicate that higher dialysate magnesium concentrations or oral supplementation can improve surrogate markers of vascular health, including less vascular calcification and stiffness. Higher dialysate concentrations may also lower cardiovascular mortality. Given encouraging but predominantly surrogate-based evidence, adequately powered randomized trials are warranted. Limitations: Most trials were small, single-center, and of short duration. They relied on surrogate endpoints, and there was heterogeneity in interventions and outcome measures.
