Medicine Hat

Researchers are evaluating the use of intravenous thrombolysis IVT with tenecteplase for patients who have suffered an acute ischemic stroke AIS. This study aims to compare the effectiveness of standard-dose tenecteplase 0.25 mgkg body weight against a lower dose 0.18 mgkg and also to assess scenarios where no tenecteplase is given upfront, particularly in patients recently taking direct oral anticoagulants DOACs or those planned for emergency endovascular thrombectomy EVT. The trial seeks to provide clearer guidance on dosing and treatment choices, especially for specific patient groups like the elderly or those with other health conditions. Participants are randomly assigned to one of three groups receiving standard-dose tenecteplase, low-dose tenecteplase, or no tenecteplase upfront if eligible for EVT or recently taking DOACs. Tenecteplase is administered as a single intravenous bolus shortly after randomization. The study design is open-label with blinded endpoint assessment and follows patients for 90 days after treatment or until death. During the study, patients will have their functional outcomes measured using the modified Rankin Scale at 90 days, with assessments done by telephone. Researchers will also track mortality, quality of life, serious adverse events, intracranial hemorrhages, and imaging outcomes related to brain infarcts and reperfusion success after EVT. Hospital stay length and ambulatory status at discharge will be recorded. Safety monitoring occurs up to 36 hours post-treatment, with imaging reviewed by blinded experts. The total participant involvement lasts up to 90 days from enrollment.

The trial focuses on moderate and late preterm infants born between 32 and 36 weeks gestation who are admitted to Level 2 and 3 Neonatal Intensive Care Units NICUs across Alberta. Researchers aim to find out if applying collaborative quality improvement methods and standardized care bundles can reduce the length of hospital stays and help babies get home faster. This stepped-wedge cluster randomized trial includes 12 NICUs randomized to adopt the intervention at different times, allowing comparison against current standard care. The intervention involves multiple collaborative quality improvement strategies building dedicated QI teams in each NICU, providing standardized QI education, implementing two care bundles focused on respiratory and nutritional support, mentoring by experienced QI members, and facilitating collaborative networking with regular virtual and in-person meetings. Participating NICUs will transition from current practices to this intervention in phases over three years. During the control period, NICUs continue their usual care and any ongoing QI activities without the new intervention strategies. Participants progress will be monitored from birth until discharge or death, with assessments continuing up to six months after their due date. Researchers will track hospital stay length, healthcare costs, respiratory support duration, feeding milestones, growth measurements, rehospitalizations, mortality, and staff perceptions of QI implementation. Data will be collected through clinical records and surveys. The study spans from May 2023 to August 2027, aiming to improve care quality and outcomes for these preterm infants.

This research aims to compare the effects of oral anticoagulation versus no anticoagulation in patients aged 55 and older who have had recent episodes of transient atrial fibrillation triggered by stress and have additional factors that increase their risk of stroke. The study is a multinational, investigator-initiated, prospective, randomized, open-label trial evaluating the impact of non-vitamin K oral anticoagulants NOACs on preventing stroke and other serious cardiovascular events. Participants will be randomly assigned to either receive one of several NOACs, such as edoxaban, apixaban, dabigatran, or rivaroxaban, prescribed by their physician for the duration of the follow-up, or to a control group that will not receive anticoagulants unless medically indicated during the study. The choice of specific NOAC and dose adjustments are determined by the prescribing doctor. The study excludes patients with certain conditions like chronic atrial fibrillation, severe kidney or liver disease, recent cardiac surgery, or bleeding risks. During the study, participants will be monitored for up to 24 months to assess the occurrence of non-hemorrhagic stroke, systemic embolism, vascular mortality, myocardial infarction, peripheral arterial thrombosis, amputation, and venous thromboembolism. Regular follow-up will include evaluation of these outcomes to measure the effectiveness and safety of anticoagulation compared to no anticoagulation. Participants will provide informed consent and remain under medical supervision throughout the trial.