Brantford

Problems with substance use are common among people who have been in prison, and these issues can increase the risk of returning to prison, especially since most substances remain illegal in Canada. Research shows that treatment can help reduce this risk, but such treatments are rarely offered in correctional settings. This pilot trial evaluates two digital treatments aimed at helping individuals recently released from prison manage substance use problems, focusing on engagement and relapse rates over six months. The study compares two digital programs: Breaking Free Online (BFO), which uses cognitive behavioral therapy and mindfulness techniques to help users reshape their thinking and manage high-risk situations, and Computer-Based Training for Cognitive Behavioural Therapy (CBT4CBT), which offers video lessons, games, quizzes, and interactive content to teach skills for avoiding substance use and handling triggers. Both programs are self-directed and accessible via smartphone, tablet, or online, allowing participants to work at their own pace. Participants will be monitored for six months to assess how well they engage with the digital treatments and their usefulness in preventing substance use relapse and re-incarceration. The study measures include treatment feasibility, overall engagement, perceived usefulness, and treatment effectiveness, with additional follow-up about three months after treatment completion to evaluate long-term outcomes related to substance use and recidivism.

Researchers are evaluating which of three approved biologic treatments for moderate-to-severe Crohn's disease affecting the small bowel (ileum) leads to the highest rate of healing without the need for corticosteroids after one year. The study focuses on patients with ileal-dominant Crohn's disease and compares anti-TNF alpha agents, anti-integrin agents, and anti-IL23 targeted therapies. All treatments are approved by Health Canada and no experimental drugs are used. Participants will be randomly assigned to one of three treatment groups at the start of the study. The anti-TNF alpha group receives infliximab intravenously or adalimumab by injection on specified schedules. The anti-integrin group receives vedolizumab intravenously or a combination of intravenous and subcutaneous doses. The anti-IL23 group receives ustekinumab or risankizumab through an intravenous dose followed by subcutaneous doses every 8 weeks. Treatment is given as part of routine clinical care, including a corticosteroid taper if patients are on steroids at baseline. Throughout the 12-month study, participants will be monitored with clinical assessments and lab tests at months 4, 8, and 12. These include disease activity scores, quality of life questionnaires, and tests for inflammation markers. At one year, an ileocolonoscopy will be performed to check if the Crohn's ulcers have healed, indicating endoscopic remission. Safety and treatment effects will be assessed during this period.

Researchers are evaluating new treatments for acute hypoxemic respiratory failure (AHRF), a serious condition affecting millions worldwide and often requiring mechanical ventilation or extracorporeal life support. This adaptive platform trial includes multiple domains that assess different therapies across a range of patient severity and investigational phases, from early mechanistic studies to full clinical trials. The study uses advanced statistical methods to efficiently test interventions focusing on mechanical ventilation, extracorporeal support, drugs, and medical devices. Participants may receive various interventions depending on the domain, including ultra-protective ventilation using VV-ECMO, lung-protective ventilation, driving pressure-limited ventilation, lung- and diaphragm-protective ventilation with sedation, corticosteroid treatments, fludrocortisone, nebulized furosemide, or inspiratory muscle training. Some domains also study ventilation strategies during extracorporeal life support or collect observational data. Treatments are delivered according to randomized assignments, sometimes involving specialized devices or adjusted ventilator settings. During the study, participants undergo assessments including physiological and biological measurements, monitoring of ventilation targets, adherence to protocols, and survival outcomes up to 60 days. Recruitment feasibility and barriers are tracked over years at multiple sites. The trial collects data on ventilator-free days, mortality, advanced respiratory support-free days, and protocol adherence. Safety and effectiveness are regularly evaluated through Bayesian adaptive analyses, with total enrollment periods ranging from months to years depending on the domain.

Researchers are evaluating the effects of two different default dialysate sodium concentrations, 137 mmol/l and 140 mmol/l, on major cardiovascular events and death in adults receiving maintenance haemodialysis. This pragmatic, cluster-randomised, open-label study takes place in real-world dialysis sites and aims to compare the outcomes associated with these sodium levels over an extended period. The study focuses on patients with end-stage kidney disease undergoing regular haemodialysis treatment. Dialysis sites are randomly assigned to use either a default dialysate sodium concentration of 137 mmol/l or 140 mmol/l for at least 90% of dialysis sessions at that site. All other care practices continue as usual based on local standards. The study plans to recruit sites over 5 to 7 years, with individual follow-up lasting roughly 2 to 5 years. Site participation requires consent, while individual patient consent may be waived or offered an opt-out option. Participants will be monitored for major cardiovascular events and death, with the primary outcome measuring the time until the first such event occurs. Data collection methods are implemented across participating dialysis units, focusing only on in-center or satellite dialysis patients where applicable. The study's duration depends on the occurrence of endpoints, with an average follow-up of about 5 years anticipated per participant.

Researchers are evaluating a range of treatments to improve outcomes for adults admitted to intensive care units (ICUs) with severe community-acquired pneumonia (CAP), including cases caused by influenza and COVID-19. This Phase 3 adaptive platform trial, REMAP-CAP, is designed to test multiple treatment strategies simultaneously and adapt over time, allowing new treatments to be added as questions are answered. The trial also serves as a platform to quickly evaluate treatments during respiratory pandemics, such as COVID-19, through a sub-study called REMAP-COVID in the United States. Participants receive various interventions including antibiotics like ceftriaxone, moxifloxacin, or piperacillin-tazobactam, as well as macrolide therapies given for different durations. Other treatments assessed include corticosteroids such as hydrocortisone and dexamethasone, antiviral agents like oseltamivir and remdesivir, immune modulators including tocilizumab and baricitinib, and supportive care strategies such as mechanical ventilation methods. Dosing and duration vary for each treatment, with some interventions now closed. Treatments are administered according to local guidelines and clinical decisions, with some requiring intravenous or enteral routes. Participants are closely monitored with assessments focusing on survival and organ support status in the ICU up to 90 days after enrollment. The main outcomes measured include all-cause mortality by day 90 and the number of days alive without needing organ support in the ICU by day 21. The study collects data continuously to adapt treatment assignments for new participants, aiming to identify the most effective therapies. Follow-up and safety monitoring continue throughout hospitalization and up to 90 days after admission.

Many adults and some children with COVID-19 or other acute respiratory infections become critically ill and need advanced care in the Intensive Care Unit (ICU). This research aims to understand how frailty, a condition of reduced function and health, affects survival and health outcomes in these patients. While frailty is known to lower survival chances in adults, its impact on critically ill children is less understood. The study also explores the role of rehabilitation in improving strength and quality of life for survivors. The study includes adults and children admitted to participating ICUs and Pediatric ICUs (PICUs) with COVID-19 or acute respiratory infections. Patients with confirmed or suspected COVID-19 or acute respiratory infections who require advanced respiratory support like invasive or non-invasive ventilation or high flow oxygen therapy within 14 days of ICU admission are included. Data on frailty levels, function, and rehabilitation therapies received will be collected during and after ICU stays. Participants will be monitored for outcomes such as survival, functional status, and frailty at hospital discharge or six months after ICU admission, whichever comes first. Researchers will track rehabilitation types and post-hospital discharge locations like home or rehabilitation centers. The findings will help improve care planning, rehabilitation practices, and quality of life for survivors of critical illness from COVID-19 or acute respiratory infections.