AimsCatheter-based radiofrequency renal denervation (RF RDN) is an interventional treatment for uncontrolled hypertension. This analysis explored the therapy's lifetime cost-effectiveness in a Canadian healthcare setting.Materials and methodsA decision-analytic Markov model was used to project health events, costs, and quality-adjusted life years over a lifetime horizon. Seven primary health states were modeled, including hypertension alone, stroke, myocardial infarction (MI), other symptomatic coronary artery disease, heart failure (HF), end-stage renal disease (ESRD), and death. Multivariate risk equations and a meta-regression of hypertension trials informed transition probabilities. Contemporary clinical evidence from the SPYRAL HTN-ON MED trial informed the base case treatment effect (-4.9 mmHg change in office systolic blood pressure (oSBP) observed vs. sham control). Costs were sourced from published literature. A 1.5% discount rate was applied to costs and effects, and the resulting incremental cost-effectiveness ratio (ICER) was evaluated against a willingness-to-pay threshold of $50,000 per QALY gained. Extensive scenario and sensitivity analyses were performed.ResultsOver 10 years, RF RDN resulted in relative risk reduction in clinical events (0.80 for stroke, 0.88 for MI, and 0.72 for HF). Under the base case assumptions, RF RDN was found to add 0.51 (15.81 vs. 15.30) QALYs at an incremental cost of $6,031 ($73,971 vs. $67,040) over a lifetime, resulting in an ICER of $11,809 per QALY gained. Cost-effectiveness findings were found robust in sensitivity analyses, with the 95% confidence interval for the ICER based on 10,000 simulations ranging from $4,489 to $22,587 per QALY gained.Limitations and conclusionModel projections suggest RF RDN, under assumed maintained treatment effect, is a cost-effective treatment strategy for uncontrolled hypertension in the Canadian healthcare system based on meaningful reductions in clinical events.

In the rapidly evolving healthcare field, artificial intelligence (AI) is emerging as a powerful tool for transforming nursing practices. AI is revolutionizing how nurses manage their responsibilities by enhancing diagnostics, personalizing patient care, and streamlining workflows. It aids in the early detection of diseases, predictive analytics, and continuous monitoring, which allows nurses to focus on complex care tasks. This is particularly evident in specialties such as pediatrics and emergency care, where AI-driven tools support early diagnosis, personalized treatment plans, and real-time patient monitoring. Despite challenges such as data privacy and equitable access, AI empowers nurses to provide more efficient, accurate, and compassionate care. Integrating AI in nursing blends advanced technology with human empathy, significantly improving patient outcomes and overall healthcare quality [1-12].

This systematic review aimed to assess the impact of educational interventions on nutritional knowledge for cancer prevention using the health belief model. Comprehensive searches were conducted in international electronic databases, including Scopus, PubMed, and Web of Science, from their inception until June 16, 2024. Keywords derived from Medical Subject Headings such as "Nutrition Knowledge", "Education", "Health Belief Model", and "Cancer" were utilized. The quality of randomized controlled trials (RCTs) and quasi-experimental studies was assessed using the Joanna Briggs Institute's (JBI) critical assessment checklist. A total of 611 participants were enrolled in five studies, with 78.39% female and 76.76% in the intervention group. The mean age of participants was 42.12 years (SD=6.47). Of the included studies, one was an RCT, while the remaining four were quasi-experimental. Three studies included a control group, and four studies incorporated a follow-up. Regarding the assessment tools used, four studies employed researcher-developed questionnaires, and one study utilized the nutrition-related cancer prevention knowledge, attitude, and practice (NUTCANKAP) questionnaire for evaluating nutritional knowledge. The mean follow-up period was approximately 14 weeks, and the average duration of the intervention was 54 minutes. Across all studies, the interventions effectively increased nutritional knowledge of cancer prevention based on the health belief model. The findings indicated that education based on the health belief model effectively increased nutritional knowledge of cancer prevention. Health professionals like nurses can use this model to enhance nutritional knowledge. It is recommended that health managers and policymakers create environments that enable health professionals to employ educational strategies based on the health belief model, thereby improving nutritional knowledge.

This systematic review was conducted to investigate the impact of reflexology on pain management in individuals diagnosed with rheumatoid arthritis. A comprehensive search was executed on international electronic databases, including Scopus, PubMed, Web of Science, and Iranian electronic library including Iranmedex and Scientific Information Database, covering the earliest available data up to January 25, 2024. The search employed keywords derived from Medical Subject Headings such as "reflexology", "pain", and "rheumatoid arthritis". The quality assessment of randomized controlled trials (RCTs) was conducted using the Joanna Briggs Institute's (JBI) critical assessment checklist. A total of four studies, encompassing 206 participants, were included in the review. Notably, 70.97% of the enrolled patients were female, with 61.17% assigned to the intervention group. The mean age of participants was 50.06 (standard deviation [SD]=8.48) years. The average study duration and follow-up period were approximately 25 and 5 weeks, respectively, with an intervention duration averaging 40 minutes. In three studies interventions were effective in decreasing pain of patients with rheumatoid arthritis. However, in one study, the intervention was not effective in decreasing pain of patients with rheumatoid arthritis. The findings indicated that health professionals, including nurses, can effectively employ reflexology as a means to alleviate pain in individuals with rheumatoid arthritis. Consequently, it is recommended that healthcare managers and policymakers create an enabling environment within hospitals, facilitating the integration of reflexology into patient care protocols. This strategic approach holds the potential for reducing the pain experienced by patients afflicted with rheumatoid arthritis.

This systematic review aimed to investigate the impact of telenursing on self-efficacy among diabetic patients. The study searched international electronic databases, including Scopus, PubMed, and Web of Science, from the earliest available records to September 15, 2023. The search used keywords derived from Medical Subject Headings, specifically "telenursing", "self-efficacy", and "diabetes mellitus". Iranian databases such as Iranmedex and the Scientific Information Database were also consulted. The quality assessment of included studies, which consisted of randomized controlled trials (RCTs) and quasi-experimental studies, was performed using the Joanna Briggs Institute's (JBI) critical assessment checklist. The review included a total of five studies involving 478 diabetic patients. Among these patients, 74.32% were female, and 52.00% were allocated to the intervention group. The average age of the participants was 48.76 (SD=7.48) years. The mean duration of the studies and their respective follow-up periods were 32.80 and 12.80 weeks, respectively. Furthermore, the average duration of the telenursing intervention was 23.33 minutes. The findings of this review indicated that telenursing can be an effective method for enhancing patient self-efficacy. The study suggests that healthcare managers and policymakers should consider establishing a platform incorporating telenursing via phone calls and alternative methods like video calls. This approach should aim to balance the costs associated with these different methods to ensure accessibility for all individuals. Consequently, other modalities can be integrated alongside traditional telephone-based telenursing to promote self-efficacy.

In recent years, machine learning (ML) has emerged as a transformative technology in healthcare, providing significant advancements in patient care and management. Burn care, which necessitates comprehensive and coordinated efforts due to the severe and multifaceted nature of burn injuries, particularly benefits from ML's capabilities. This literature review investigates how ML enhances the collaboration between physicians and nurses in managing burn patients. In the present study, significant findings show that ML's predictive analytics can predict patient outcomes and complications, helping with proactive care strategies. ML-driven decision support systems offer real-time, evidence-based recommendations, ensuring consistent care approaches. In addition, ML-powered virtual simulations improve training and comprehension of roles, while advanced electronic health records (EHR) systems streamline documentation and information sharing. Continuous quality improvement is supported by ML's data-driven insights, leading to improved patient monitoring and management. Ultimately, integrating ML in burn care significantly improves physician-nurse collaboration, resulting in better patient outcomes. This includes reduced infection rates and shorter hospital stays. This highlights the vital role of ML in transforming healthcare delivery and professional collaboration in managing complex conditions like burn injuries.

Purpose of Review: Chronic kidney disease (CKD)-associated pruritus is a common, persistent, and distressing itch experienced by patients across the CKD spectrum. Although the disorder is associated with adverse outcomes and poor health-related quality of life, it remains underdiagnosed and undertreated. The purpose of this narrative review is to offer health care providers guidance on how to effectively identify, assess, and treat patients with CKD-associated pruritus, with the goal of reducing symptom burden and improving patient-important outcomes, such as quality of life (QoL). Sources of Information: A panel of nephrologists and researchers from across Canada and the United States was assembled to develop this narrative review based on the best available data, current treatment guidelines, and their clinical experiences. Methods: A panel of nephrologists who actively care for patients with pruritus receiving dialysis from across Canada was assembled. Two researchers from the United States were also included based on their expertise in the diagnosis and management of CKD-associated pruritus. Throughout Spring 2023, the panel met to discuss key topics in the identification, assessment, and management of CKD-associated pruritus. Panel members subsequently developed summaries of the pertinent information based on the best available data, current treatment guidelines, and added information on their own clinical experiences. In all cases, approval of the article was sought and achieved through discussion. Key Findings: This narrative review provides pragmatic guidance addressing: (1) methods for screening CKD-associated pruritus, (2) assessing severity, (3) management of CKD-associated pruritus, and (4) suggested areas for future research. The panel developed a 3-pillar framework for proactive assessment and severity scoring in CKD-aP: systematic screening for CKD-associated pruritus (pillar 1), assessment of pruritus intensity (pillar 2), and understanding the impact of CKD-associated pruritus on the patient’s QoL (pillar 3). Management of CKD-associated pruritus can include ensuring optimization of dialysis adequacy, achieving mineral metabolism targets (ie, calcium, phosphate, and parathyroid hormone). However, treatment of CKD-associated pruritus usually requires additional interventions. Patients, regardless of CKD-associated pruritus severity, should be counseled on adequate skin hydration and other non-pharmacological strategies to reduce pruritus. Antihistamines should be avoided in favor of evidence-based treatments, such as difelikefalin and gabapentin. Limitations: A formal systematic review (SR) of the literature was not undertaken, although published SRs were reviewed. The possibility for bias based on the experts’ own clinical experiences may have occurred. Key takeaways are based on the current available evidence, of which head-to-head clinical trials are lacking. Funding: This work was funded by an arm’s length grant from Otsuka Canada Pharmaceutical Inc. (the importer and distributer of difelikefalin in Canada). LiV Medical Education Agency Inc. provided logistical and editorial support.

Burn injuries represent a significant global health challenge, leading to substantial morbidity and mortality. Effective burn wound management is critical to improving patient outcomes and optimizing healthcare resources. This study explores the transformative potential of artificial intelligence (AI) in enhancing diagnostic accuracy, personalizing treatment plans, optimizing resource allocation, and improving patient outcomes in burn care. The study addresses the significant challenges of implementing AI in this field. The review identified several opportunities for AI in burn wound management, including enhanced diagnostic accuracy through machine learning algorithms, early detection of complications via continuous monitoring, optimized resource allocation, improved surgical outcomes with AI-assisted planning, and personalized rehabilitation programs. However, challenges such as data quality and standardization, bias in AI models, ethical and privacy concerns, and integration with existing healthcare systems were also highlighted. The "black box" nature of AI, regulatory hurdles, and the need for clinician training pose additional barriers to implementation. AI has the potential to revolutionize burn wound management by providing more precise and efficient care. To realize these benefits, addressing challenges related to data quality, bias, ethical issues, and technical integration is crucial. Standardized data protocols, robust governance frameworks, continuous clinician education, and transparent regulatory guidelines are essential for effective AI integration. Ongoing research and collaboration between technologists, clinicians, and policymakers are vital to fully harness AI’s potential in burn carefully, ultimately enhancing patient outcomes and advancing the field.

The objective of this systematic review is to assess the extent of nursing students' knowledge concerning palliative care and identify potential factors that may impact it. To carry out their comprehensive and review research, items were searched from the starting point to March 1, 2023, applying keywords gathered from Medical Subject Headings such as "knowledge", "palliative care", and "nursing students" in global online databases involving Scopus, PubMed, Web of Science, and Iranian electronic library including Iranmedex and Scientific Information Database. Using the assessment instrument for cross-sectional studies (AXIS tool), the quality of the studies included in this systematic review was determined. In total, 4,320 nursing students participated in eleven cross-sectional studies. The average nursing student's knowledge of palliative care was 8.94 (standard deviation [SD]=3.57) out of 20; the results have shown an insufficient level of knowledge. Factors such as age, female gender, encounter with terminally ill patients, receiving a non-university educational session, year of study, being mature, and receiving a university educational session have a potential positive correlation with nursing students' knowledge of palliative care. Furthermore, the investigation revealed that the following variables had a statistically significant association with nursing students' level of knowledge in palliative care: academic year, perception of death as the cessation of life, receipt of university educational sessions, teaching content related to palliative care, type of university, academic grade, gender, place of birth, monthly family income, religious beliefs, and experience of providing care to a dying family member. Thus, it is recommended that future studies focus on implementing appropriate interventions for nursing students to enhance their level of knowledge regarding palliative care.

Oral exercises as a rehabilitation strategy can be performed by the elderly at any time and place without any complications or financial burden. Therefore, an oral exercise that is easy to perform and follow in daily life, can effectively improve the oral health of the elderly. This systematic review was conducted to investigate the effect of oral exercises on swallowing function in the elderly. A comprehensive systematic search was conducted on international electronic databases such as Scopus, PubMed, Web of Science, as well as on Iranian electronic databases such as Iranmedex, and Scientific Information Database from the earliest to April 1, 2023. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to assess the quality of randomized control trials and quasi-experimental studies. A total of 728 elderly people participated in fourteen studies. Based on the results of the present systematic review, ten interventions including “lingual resistance exercise with Iowa oral performance instrument”, “exercise for swallowing”, “oral exercise”, “expiratory muscle strength training”, “swallow resistance exercise”, “swallowing exercises”, “oral neuromuscular training”, “simple oral exercise (SOE)”, “tongue strengthening exercise”, “SOE and chewing gum exercise with SOE” improved swallowing function in the elderly. However, the other four interventions including “swallowing exercises”, “resistance training”, “effortful swallowing exercise”, and “oral exercises” did not affect improving swallowing function in the elderly. Health managers and policymakers can improve the swallowing performance of the elderly by implementing training protocols related to oral exercise in addition to routine interventions.

This systematic review aims to examine the nursing students' knowledge and related factors towards skin cancer. In order to conduct this comprehensive and review study, articles were searched from the earliest to April 1, 2023 using keywords extracted from Medical Subject Headings such as "knowledge", "skin cancer", and "nursing students" in various international electronic databases such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex and Scientific Information Database. The appraisal tool for cross-sectional studies (AXIS tool) was used to evaluate the quality of the studies included in this article. In total, 2,841 nursing students participated in five cross-sectional studies. The average age of the students was 20.93 (SD=1.89). 78.07% of the students in this study were female. 19.70% of students had a history of skin cancer in their family member. The average nursing students' knowledge and related factors towards skin cancer was 14.78 (SD=2.68) out of 25 which suggests a moderate level of knowledge. Factors such as year of study, female gender, age, using cosmetics, using depilatory wax, using epilating appliance, skin cancer caused by sun exposure, and protection of information have a significant positive relationship with nursing students' knowledge about skin cancer. However, knowledge had a negative relationship with factors such as using shaving, having mole, and having swelling. Additionally, the factors of father education, place of residence, sunburn frequency, source information had a significant relationship with nursing students' knowledge about skin cancer. According to the results of this review, the knowledge of nursing students in skin cancer is moderate. Therefore, nursing professors may contribute to the development of nursing students' knowledge by providing an online or physical education platform related to skin cancer.

This systematic review investigated the impact of acupressure on sleep quality among patients undergoing cardiac surgery. Major electronic databases including Scopus, PubMed, and Web of Science were systematically searched from the earliest records to November 1, 2023, using relevant Medical Subject Headings such as "acupressure", "sleep", and "cardiac surgical procedures". Additionally, Iranian databases like Iranmedex were consulted. The quality of randomized controlled trials (RCTs) and quasi-experimental studies was assessed using the Joanna Briggs Institute's (JBI) critical assessment checklist. A total of four studies involving 262 patients were included, with 60.37% being male and 53.82% assigned to the intervention group. Participants had an average age of 58.56 years (SD=8.68). The average study duration was approximately 45 weeks with a 6-day follow-up, and the typical intervention duration was 14.25 minutes. In all studies, interventions were effective in increasing sleep quality. The findings indicated that acupressure administered by healthcare professionals, such as nurses, could enhance sleep quality. The recommendation suggests that healthcare managers and policymakers create an environment in healthcare settings, that enabling nurses and other professionals to employ acupressure, thereby improving the sleep quality of patients undergoing cardiac surgery.

This systematic review aimed to investigate the extent of nursing students' knowledge regarding climate change and its impact on health. A comprehensive and systematic review was conducted across several international electronic databases, including Scopus, PubMed, and Web of Science. The search employed keywords based on Medical Subject Headings, including "knowledge", "climate change", "nursing students", and "health". The search period was extended from these databases’ inception until May 28, 2024. The quality of the studies included in this review was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS tool). The systematic review encompassed five cross-sectional studies, collectively involving 2,150 nursing students. Among these participants, females constituted 75.81%. The geographical distribution of the studies included in this systematic review spanned several countries: Egypt (n=3), Saudi Arabia, Iraq and Palestine (n=1), China (n=1), and the United States (n=1). Findings from three studies indicate that nursing students’ mean knowledge level regarding climate change’s impact on health is 63.70%. The knowledge level of nursing students regarding climate change’s impact on health was moderate. Factors including education level, practice, academic year, gender, and rural areas were related to nursing students’ knowledge about climate change and its effect on health. Policymakers and healthcare administrators must enhance the educational framework by prioritizing factors that influence the knowledge base of nursing students. These factors include academic level, geographic location (such as rural areas), gender, and clinical practice experience.

This systematic review was conducted with the objective of assessing the nurses' knowledge and related factors towards hemodialysis patients' nutrition. A thorough and systematic search was executed across various international electronic databases, including Scopus, PubMed, and Web of Science, as well as Persian electronic databases such as Iranmedex and the Scientific Information Database. The search utilized keywords derived from Medical Subject Headings, including “knowledge”, “nurses”, “hemodialysis”, and “nutrition”, and covered all available literature up to March 11, 2024. The quality of the studies incorporated into this systematic review was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS tool). The review encompassed six cross-sectional studies, involving a total of 455 hemodialysis nurses. Among the participants, 57.47% were female. The geographical distribution of the studies included in this review was as follows: four studies were conducted in Iraq, one in Italy and one in Greece. The mean nutritional knowledge score among hemodialysis nurses, as reported in six studies, was 57.40 out of 100. This score suggests a moderate level of nutritional knowledge among the nurses. Several factors, such as age, level of education, and years of experience, were identified as being associated with the nutritional knowledge of hemodialysis nurses. Therefore, it is recommended that nursing policymakers and managers focus on these factors to enhance the nutritional knowledge among hemodialysis nurses. This could potentially lead to improved patient outcomes in the hemodialysis setting.

Purpose of review: Kidney disease is present in almost half of Canadian patients with type 2 diabetes (T2D), and it is also the most common first cardiorenal manifestation of T2D. Despite clear guidelines for testing, opportunities are being missed to identify kidney diseases, and many Canadians are therefore not receiving the best available treatments. This has become even more important given recent clinical trials demonstrating improvements in both kidney and cardiovascular (CV) endpoints with sodium-glucose cotransporter 2 (SGLT2) inhibitors and a nonsteroidal mineralocorticoid receptor antagonist, finerenone. The goal of this document is to provide a narrative review of the current evidence for the treatment of diabetic kidney disease (DKD) that supports this new standard of care and to provide practice points. Sources of information: An expert panel of Canadian clinicians was assembled, including 9 nephrologists, an endocrinologist, and a primary care practitioner. The information the authors used for this review consisted of published clinical trials and guidelines, selected by the authors based on their assessment of their relevance to the questions being answered. Methods: Panelists met virtually to discuss potential questions to be answered in the review and agreed on 10 key questions. Two panel members volunteered as co-leads to write the summaries and practice points for each of the identified questions. Summaries and practice points were distributed to the entire author list by email. Through 2 rounds of online voting, a second virtual meeting, and subsequent email correspondence, the authors reached consensus on the contents of the review, including all the practice points. Key findings: It is critical that DKD be identified as early as possible in the course of the disease to optimally prevent disease progression and associated complications. Patients with diabetes should be routinely screened for DKD with assessments of both urinary albumin and kidney function. Treatment decisions should be individualized based on the risks and benefits, patients’ needs and preferences, medication access and cost, and the degree of glucose lowering needed. Patients with DKD should be treated to achieve targets for A1C and blood pressure. Renin-angiotensin-aldosterone system blockade and treatment with SGLT2 inhibitors are also key components of the standard of care to reduce the risk of kidney and CV events for these patients. Finerenone should also be considered to further reduce the risk of CV events and chronic kidney disease progression. Education of patients with diabetes prescribed SGLT2 inhibitors and/or finerenone is an important component of treatment. Limitations: No formal guideline process was used. The practice points are not graded and are not intended to be viewed as having the weight of a clinical practice guideline or formal consensus statement. However, most practice points are well aligned with current clinical practice guidelines.

Purpose of review: Thrombotic microangiopathy (TMA) is suspected in patients presenting with thrombocytopenia and evidence of a microangiopathic hemolytic anemia. Patients with TMA can be critically ill, so rapid and accurate identification of the underlying etiology is essential. Due to better insights into pathophysiology and causes of TMA, we can now categorize TMAs as thrombotic thrombocytopenic purpura, postinfectious (mainly Shiga toxin-producing Escherichia coli–induced) hemolytic uremic syndrome (HUS), TMA associated with a coexisting condition, or atypical HUS (aHUS). We recognized an unmet need in the medical community to guide the timely and accurate identification of TMA, the selection of tests to clarify its etiology, and the sequence of steps to initiate treatment. Sources of information: Key published studies relevant to the identification, classification, and treatment of TMAs in children or adults. These studies were obtained through literature searches conducted with PubMed or based on the prior knowledge of the authors. Methods: This review is the result of a consultation process that reflects the consensus of experts from Canada, the United States, and the United Arab Emirates. The members represent individuals who are clinicians, researchers, and teachers in pediatric and adult medicine from the fields of hematology, nephrology, and laboratory medicine. Authors, through an iterative review process identified and synthesized information from relevant published studies. Key findings: Thrombotic thrombocytopenic purpura occurs in the setting of insufficient activity of the von Willebrand factor protease known as ADAMTS13. Shiga toxin-producing Escherichia coli–induced hemolytic uremic syndrome, also known as “typical” HUS, is caused by gastrointestinal infections with bacteria that produce Shiga toxin (initially called verocytotoxin). A variety of clinical conditions or drug exposures can trigger TMA. Finally, aHUS occurs in the setting of inherited or acquired abnormalities in the alternative complement pathway leading to dysregulated complement activation, often following a triggering event such as an infection. It is possible to break the process of etiological diagnosis of TMA into 2 distinct steps. The first covers the initial presentation and diagnostic workup, including the processes of identifying the presence of TMA, appropriate initial tests and referrals, and empiric treatments when appropriate. The second step involves confirming the etiological diagnosis and moving to definitive treatment. For many forms of TMA, the ultimate response to therapies and the outcome of the patient depends on the rapid and accurate identification of the presence of TMA and then a standardized approach to seeking the etiological diagnosis. We present a structured approach to identifying the presence of TMA and steps to identifying the etiology including standardized lab panels. We emphasize the importance of early consultation with appropriate specialists in hematology and nephrology, as well as identification of whether the patient requires plasma exchange. Clinicians should consider appropriate empiric therapies while following the steps we have recommended toward definitive etiologic diagnosis and management of the TMA. Limitations: The evidence base for our recommendations consists of small clinical studies, case reports, and case series. They are generally not controlled or randomized and do not lend themselves to a stricter guideline-based methodology or a Grading of Recommendations Assessment, Development and Evaluation (GRADE)-based approach.

A recent acute coronary syndrome provides an opportunity to optimise secondary prevention strategies to reduce the risk of future cardiovascular events. This review provides an updated synopsis of current evidence-based approaches. New clinical trial data on the use of antiplatelet and anticoagulants allow choices of the selection and duration of treatment. Lipid lowering after an acute coronary syndrome is now enhanced, with proprotein convertase subtilisin-kexin type 9 inhibitors providing added benefit on top of statin and ezetimibe treatment in high-risk patients. In addition, a recent trial of icosapent ethyl, a highly purified ethyl ester of eicosapentaenoic acid, addresses residual risk in patients with elevated triglycerides already treated with statins. The use of both sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes reduces cardiovascular events independently of glucose lowering.

Hypertension Canada's 2020 guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children provide comprehensive, evidence-based guidance for health care professionals and patients. Hypertension Canada develops the guidelines using rigourous methodology, carefully mitigating the risk of bias in our process. All draft recommendations undergo critical review by expert methodologists without conflict to ensure quality. Our guideline panel is diverse, including multiple health professional groups (nurses, pharmacy, academics, and physicians), and worked in concert with experts in primary care and implementation to ensure optimal usability. The 2020 guidelines include new guidance on the management of resistant hypertension and the management of hypertension in women planning pregnancy.

BACKGROUND AND OBJECTIVES:Canadian home hemodialysis guidelines highlight the potential differences in complications associated with arteriovenous fistula (AVF) cannulation technique as a research priority. Our primary objective was to determine the feasibility of randomizing patients with ESKD training for home hemodialysis to buttonhole versus stepladder cannulation of the AVF. Secondary objectives included training time, pain with needling, complications, and cost by cannulation technique. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:All patients training for home hemodialysis at seven Canadian hospitals were assessed for eligibility, and demographic information and access type was collected on everyone. Patients who consented to participate were randomized to buttonhole or stepladder cannulation technique. Time to train for home hemodialysis, pain scores on cannulation, and complications over 12 months was recorded. For eligible but not randomized patients, reasons for not participating in the trial were documented. RESULTS:Patient recruitment was November 2013 to November 2015. During this time, 158 patients began training for home hemodialysis, and 108 were ineligible for the trial. Diabetes mellitus as a cause of ESKD (31% versus 12%) and central venous catheter use (74% versus 6%) were more common in ineligible patients. Of the 50 eligible patients, 14 patients from four out of seven sites consented to participate in the study (28%). The most common reason for declining to participate was a strong preference for a particular cannulation technique (33%). Patients randomized to buttonhole versus stepladder cannulation required a shorter time to complete home hemodialysis training. We did not observe a reduction in cannulation pain or complications with the buttonhole method. Data linkages for a formal cost analysis were not conducted. CONCLUSIONS:We were unable to demonstrate the feasibility of conducting a randomized, controlled trial of buttonhole versus stepladder cannulation in Canada with a sufficient number of patients on home hemodialysis to be able to draw meaningful conclusions.

Background Little evidence exists regarding optimal peritoneal dialysis (PD) access insertion pathways, benchmarking for patency targets, and definitions of access dysfunction. Methods This quality improvement (QI) project evaluated patients with PD catheters inserted at a single center in Toronto, Canada, following: establishment of PD catheter insertion protocols, a PD access coordinator, PD access operator training, and outcomes reporting. We define primary vs secondary PD catheter dysfunction by presentation before/after initial home PD treatment. We report catheter dysfunction rates, interventions restoring PD catheter patency (interventional radiology [IR] vs advanced laparoscopic [AL]) (embedded vs non-embedded) between 2012 and 2017. Results A total of 297 first PD catheters were inserted between January 2012 and December 2017. Interventional radiology PD catheters ( n = 94) were placed in older patients with greater comorbidities and less prior abdominal surgery than AL-placed catheters. Indications for IR insertion included need for urgent dialysis given resource availability (36.2% [ n = 34]) and prohibitive surgical risk (26.6% [ n = 25]). Interventional radiology-inserted catheters had overall (primary and secondary) dysfunction rates of 17%. Non-embedded AL catheters had 16.1% overall dysfunction. Embedded AL-inserted PD catheters had a 24.6% overall dysfunction rate. Among all dysfunctional catheters, IR manipulation was successful in 31% ( n = 11), and surgical revision was necessary in all unsuccessful cases with either lysis of adhesions or omentopexy to establish patency. Conclusion Our PD catheter QI initiative involved tracking, outcome reporting, defining PD catheter dysfunction and PD access insertion pathway development, yielding important insights into opportunities for program improvement. Multicenter research initiatives are needed to further improve PD access dysfunction definitions and to establish the best benchmarks for these metrics.