Brantford

Substance use problems are common among people who have been in prison. Since many substances remain illegal in Canada, these problems can increase the chance of returning to prison. This research is studying two digital treatments for substance use disorders in individuals recently released from prison to see how well they work and how engaged participants are over six months. The study also looks at rates of relapse and re-incarceration. Participants will be randomly assigned to one of two digital programs. One group will complete a 7-module program based on cognitive behavioural therapy CBT techniques. The other group will complete a 6-module program that combines CBT and mindfulness. Both programs are self-directed and designed to help users manage triggers and avoid substance use. During the study, participants will use their assigned digital treatment over six months. Researchers will assess how feasible and useful each program is, how engaged participants remain, and the effectiveness of the treatments in reducing substance use and re-incarceration. Follow-up evaluations will occur about three months after treatment completion to measure outcomes and gather feedback.

Researchers are evaluating which of three types of approved biologic treatmentsanti-tumor necrosis factor TNF alpha, anti-integrin, or anti-interleukin IL-23 agentsis most effective for patients with moderate-to-severe Crohns disease that primarily affects the small bowel ileal region. The study aims to find out which treatment leads to the highest number of patients achieving healing of small bowel ulcers without needing corticosteroids after one year. This phase 4 trial uses treatments already approved by Health Canada. Participants will be randomly assigned to one of three treatment groups TNF alpha antagonists infliximab given intravenously or adalimumab injected under the skin, anti-integrin agents vedolizumab administered intravenously or intravenously plus subcutaneously, or anti-IL23 agents ustekinumab or risankizumab given intravenously then subcutaneously. All treatments follow standard care dosing schedules with initial doses followed by maintenance doses at regular intervals. Those on corticosteroids will begin tapering within six weeks of starting biologics. During the 12-month study, participants will be monitored at months 4, 8, and 12 for clinical symptoms, quality of life, and biomarkers like C-reactive protein and fecal calprotectin. At the end of the study, a video-recorded ileocolonoscopy will assess healing of ileal ulcers. Other outcomes include tracking Crohns disease complications, treatment persistence, and safety. Participants will be followed according to routine care guidelines throughout the trial.

Researchers are evaluating new treatments for acute hypoxemic respiratory failure AHRF, a serious condition that affects millions worldwide each year and carries high risks of death and long-term health problems. This platform trial, called PRACTICAL, uses adaptive methods to test various interventions at different stages, including mechanical ventilation approaches, extracorporeal life support, drugs, and medical devices. The study aims to find better strategies to protect lungs and diaphragm function during ventilation and improve patient outcomes. The trial includes multiple domains studying different treatments or strategies. These include ultra-protective ventilation using extracorporeal carbon dioxide removal, various invasive mechanical ventilation strategies, corticosteroid use in early and extended phases, nebulized furosemide, positive end-expiratory pressure settings during extracorporeal support, fludrocortisone for airspace disease, and inspiratory muscle training. Some domains are observational, collecting data and biomarkers in immunocompromised patients or examining patient-ventilator interactions. Participants will be randomized to different treatment arms or observed, depending on the domain. Participants will undergo assessments including physiological and biological measurements, mechanical ventilation monitoring, and evaluation of clinical outcomes such as mortality, ventilator-free days, organ failure, and long-term cognitive and physical function. Data will be collected daily or at specified time points up to 180 days. The study uses Bayesian adaptive analysis to efficiently evaluate efficacy and safety of interventions. The total participation time varies by domain but includes active treatment periods, follow-up, and feasibility assessments over months to years.

Researchers are evaluating the impact of two different default dialysate sodium concentrations on major cardiovascular events and death in adults receiving maintenance haemodialysis for end-stage kidney disease. This pragmatic, cluster-randomised, open-label Phase 4 study compares sodium levels of 137 mmoll and 140 mmoll in real-world dialysis settings across multiple sites globally. Dialysis sites will be randomly assigned to use either a default dialysate sodium concentration of 137 mmoll or 140 mmoll for at least 90% of dialysis sessions. Other aspects of patient care will follow standard local practices. Sites must consent to participate, and individual patients will provide waiver or opt-out consent. The study expects to enroll sites over 5 to 7 years, with each participant followed for approximately 2 to 5 years until the study endpoints are reached. Participants will receive dialysis at their assigned sites with the designated sodium concentration. Researchers will monitor the time to first occurrence of major cardiovascular events or death as the primary outcome. Secondary outcomes include other cardiovascular events and individual components of the composite outcomes. Data collection and patient monitoring will continue throughout the study period, estimated to last around five years per participant.

Researchers are evaluating treatments for community-acquired pneumonia CAP, especially in patients admitted to intensive care units ICUs. This trial also adapts to study treatments for respiratory pandemics like COVID-19. The goal is to determine which treatment strategies improve outcomes for patients with severe pneumonia, using a flexible, ongoing approach that can test multiple therapies simultaneously and update as new information becomes available. Participants receive different treatment strategies based on random assignment to study groups. Treatments include various antibiotics, steroids, antivirals, immune modulators, anticoagulation methods, and ventilation strategies. Some treatment options have been closed to recruitment, reflecting the trials adaptive nature. The trial includes several domains targeting specific infections such as influenza and COVID-19, with dosing and duration guided by clinical practice and local guidelines. During the study, participants are monitored closely with assessments including survival up to 90 days, days alive without organ support in ICU, ICU and hospital length of stay, ventilator-free days, organ failure-free days, and quality of life up to 6 months. Researchers collect detailed data on patient outcomes, organ support needs, and hospital discharge status. The study runs until February 2028, with ongoing evaluation to improve pneumonia treatment strategies in ICU settings and during respiratory pandemics.

Researchers are studying adults and children who have survived COVID-19 or acute respiratory infections and were critically ill in intensive care units ICUs. This study aims to understand how frailty, a condition of reduced health and function, affects survival and health outcomes after critical illness. It also examines the types of rehabilitation patients receive and the impact on their quality of life. The study includes both adults and pediatric patients admitted to participating ICUs and pediatric ICUs PICUs. Participants include adults aged 18 and older and children under 18 who were diagnosed with COVID-19, multi-system inflammatory syndrome in children MIS-C, or other acute respiratory infections. Eligible patients required advanced respiratory support such as invasive or non-invasive ventilation or high-flow oxygen within 14 days of ICU admission. The study observes patients without altering their care, gathering data about their frailty level, function, therapies, and rehabilitation received during and after ICU stay. During the study, researchers will collect information on frailty using the Clinical Frailty Score for adults and the Functional Status Score for children at hospital discharge and six months after ICU admission. They will also assess adults daily living activities and quality of life and childrens fatigue and well-being through specific questionnaires. The study will track post-hospital discharge locations and health outcomes to better understand rehabilitation needs and improve future treatments. Participation lasts through hospital discharge and up to six months post-ICU admission.