Medicine Hat

Researchers are conducting a phase 3, randomized controlled trial to evaluate the best dosing and use of intravenous tenecteplase for patients with acute ischemic stroke (AIS). The study aims to compare standard-dose tenecteplase (0.25 mg/kg) versus low-dose tenecteplase (0.18 mg/kg) and to assess whether intravenous thrombolysis should be used in patients who recently took direct oral anticoagulants (DOACs) or are eligible for emergency endovascular thrombectomy (EVT). The study also examines how patient factors like diabetes, prior antiplatelet therapy, renal failure, frailty, age, and brain imaging findings influence treatment effects. Participants will be randomly assigned to receive either standard-dose or low-dose intravenous tenecteplase, or no tenecteplase upfront with rescue intra-arterial tenecteplase if needed in EVT-eligible patients. Those who took DOACs within 48 hours before stroke onset may not receive tenecteplase initially. The treatments involve a single intravenous bolus of tenecteplase. The trial follows patients for 90 days after treatment or until death if earlier. During the study, participants will undergo evaluations including assessments of functional dependence using the modified Rankin Scale at 90 days. Researchers will monitor safety and effectiveness, focusing on reducing disability after stroke. The trial includes blinded outcome assessment and gathers data to guide clinical decisions on thrombolysis dosing and use in various patient groups. Total participation lasts up to 90 days from enrollment.

Researchers are evaluating collaborative quality improvement (QI) strategies to standardize care for infants born between 32 and 36 weeks gestation in neonatal intensive care units (NICUs) across Alberta. This stepped-wedge cluster randomized trial aims to determine if using validated QI methods and evidence-based care bundles can reduce the length of hospital stay and help babies go home sooner. The study involves 12 NICUs, including Level 2 and Level 3 units, and tracks outcomes until babies reach a corrected age of six months. The intervention group will receive a set of collaborative QI strategies including QI team building, standardized QI education through workshops, implementation of care bundles for respiratory and nutritional support, mentoring by experienced QI members, and collaborative networking with regular virtual and annual meetings. These care bundles involve best practices for respiratory stabilization and nutritional support tailored for moderate and late preterm infants. The control group will continue their current care practices during the first year before transitioning to the intervention. Each NICU will transition to the intervention arm in stages over three years. Participants will be monitored from birth until discharge home or death, with length of hospital stay as the primary outcome. The study collects data on care practices and outcomes, provides ongoing feedback to NICUs through reports and meetings, and includes surveys and interviews with NICU staff. This comprehensive approach aims to improve care consistency and outcomes for preterm infants across the province.

Researchers are evaluating the use of non-vitamin K oral anticoagulants (NOACs) compared to no anticoagulation in people who have experienced transient atrial fibrillation episodes triggered by stress and have additional risk factors for stroke. This multinational, investigator-initiated Phase 4 trial aims to prevent stroke and other serious cardiovascular events in this group by assessing the effects of NOACs on two main outcomes: the occurrence of non-hemorrhagic stroke or systemic embolism, and a combination of vascular death and other major cardiovascular problems, over a follow-up period lasting until the last participant reaches 24 months of observation. Participants in the study are randomly assigned to either receive one of several NOAC medications—edoxaban, apixaban, dabigatran, or rivaroxaban—with dosing adjusted as needed and chosen by their prescribing doctor, or to receive no oral anticoagulation. The treatment continues throughout the follow-up period. The trial is open-label, meaning both researchers and participants know which treatment is given. The study specifically focuses on patients who had transient atrial fibrillation related to stress, such as after certain surgeries or acute medical illness. During the study, participants undergo regular monitoring to track the incidence of stroke, embolism, vascular death, heart attacks, blood clots, and other cardiovascular events. Researchers collect information over up to two years to evaluate these outcomes. Safety and adherence to treatment are also monitored. This thorough follow-up helps determine the impact of NOAC treatment compared to no anticoagulation in this particular patient population.