St Albert

This research aims to compare two common surgical procedures, Total Shoulder Arthroplasty (TSA) and Reverse Total Shoulder Arthroplasty (RTSA), in patients aged 65 and older with advanced shoulder osteoarthritis (OA). Shoulder OA is a common condition in older adults that significantly affects quality of life. The study will provide important information about which surgery may offer better function and quality of life with fewer complications within the first year after surgery. It will also assess the feasibility of conducting a larger clinical trial in this population. Participants will be randomly assigned to receive either TSA or RTSA surgery. Both procedures involve replacing parts of the shoulder joint but differ in technique and components used. Pre-operative CT imaging and surgical planning software will help guide the surgeries to correct joint alignment. After surgery, participants will be followed up at 6 weeks, and then at 3, 6, and 12 months with physical assessments and questionnaires to measure shoulder movement, strength, pain, and quality of life. During the study, researchers will collect detailed data including shoulder range of motion, strength, pain levels, and several health-related quality of life questionnaires. They will also monitor for any complications or adverse events. The main outcome measured will be the change in the Western Ontario Osteoarthritis of the Shoulder (WOOS) score over 12 months. This pilot trial involves 40 participants and aims to help plan a larger study by examining recruitment and retention rates as well as refining eligibility criteria.

Researchers are evaluating a standardized pathway for delivering acute renal replacement therapy (RRT) in intensive care units (ICUs) across Alberta. The goal is to reduce program and healthcare system costs while improving important patient-reported outcomes for patients with acute renal injury. This effort addresses the current lack of a uniform approach to prescribing and delivering acute dialysis therapy in ICUs. The study involves implementing evidence-based best practices through quarterly key performance indicator (KPI) reports and individualized prescriber reports. These prescriber reports focus on initiation patterns of acute RRT and include targeted education to align treatment with best evidence-based practices. The program covers all patients receiving acute dialysis therapy in 15 adult and 3 pediatric ICUs in Alberta during the intervention period. Participants will receive acute RRT as part of their usual care. Researchers will monitor key performance indicators throughout the intervention period, lasting up to three years, and evaluate health system costs over the same time frame. The study aims to improve the delivery of acute dialysis therapy while ensuring safety and cost-effectiveness in critically ill patients.

Researchers are investigating whether a lower dose-intensity of continuous renal replacement therapy (CRRT) is as effective as the current standard dose for critically ill patients with acute kidney injury (AKI) in intensive care units. This trial aims to determine if the lower dose is non-inferior in outcomes like kidney recovery and duration of CRRT, while also exploring potential benefits such as reduced treatment duration and cost-effectiveness. Previous studies suggested higher doses might not improve outcomes and could prolong kidney recovery, prompting this study to evaluate lower dose levels. Participants receive continuous renal replacement therapy, a continuous form of dialysis used in the ICU for patients with multi-organ failure. The study compares the current guideline-recommended CRRT dose-intensity with a lower dose-intensity, monitoring effects on treatment duration and kidney recovery. This trial is a pilot designed to inform a larger randomized controlled trial to provide high-quality evidence on the optimal dose-intensity for CRRT. During the study, participants are closely monitored to measure the delivered CRRT dose-intensity over approximately one month. Researchers assess kidney function recovery, duration of CRRT treatment, and other health outcomes. Consent is obtained prior to participation, and safety and adherence to the protocol are carefully tracked throughout the trial to ensure reliable and safe evaluation of the lower dose approach.

Researchers are evaluating two types of partial wrist fusion surgeries for adults with post-traumatic wrist arthritis, specifically those with stage II or III scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC). The study is a multi-center, double-blind, randomized clinical trial aimed at comparing clinical and radiographic outcomes between these surgical techniques to help guide surgeons in selecting the best wrist fusion method for affected patients. Participants will be randomly assigned to one of two groups: Group A will undergo four-corner arthrodesis, which involves excision of the scaphoid and fusion of the lunate, capitate, triquetrum, and hamate bones. Group B will have partial wrist arthrodesis with triquetral excision, where both the scaphoid and triquetrum are removed, followed by fusion of either the lunate, capitate, and hamate bones (three-corner arthrodesis) or just the lunate and capitate bones (capitolunate arthrodesis). These surgeries are performed as salvage techniques for wrist arthritis. Participants will have a pre-operative assessment and follow-up visits at 6 weeks, 3 months, 6 months, and 12 months after surgery. At each visit, grip strength, wrist range of motion, pain levels, and patient-reported questionnaires about wrist function and disability will be collected. X-rays of the wrist will be taken at all visits, and any complications will be recorded. The main outcome measured is grip strength, tracked over 12 months. The study uses blinded assessors and statistical methods to compare outcomes between the two surgical groups.

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.

Researchers are evaluating a new method of adjusting positive end-expiratory pressure (PEEP) using esophageal pressure measurements in patients with a high body mass index (BMI) who need mechanical ventilation. This Phase 2 study focuses on patients with a BMI of 30 kg/m2 or higher who are experiencing respiratory failure and require invasive ventilation. The main goal is to determine if a larger trial can be done, while also comparing effects on PEEP levels, lung mechanics, and clinical outcomes between groups. Participants will be randomly assigned to one of two groups: one group will receive PEEP adjustments guided by esophageal pressure using a balloon catheter inserted within four hours of randomization, while the other group will receive standard care without esophageal pressure monitoring. The esophageal pressure-guided group aims to keep end-expiratory transpulmonary pressure between 0-2 cmH2O, with adjustments made twice daily and safety limits enforced. The catheter will be removed at extubation or after 28 days. The standard care group will have PEEP managed per usual institutional protocols. During the study, patients will be monitored closely for respiratory mechanics and clinical outcomes. The main outcome is to assess the feasibility of conducting a larger study over 14 months. Researchers will also observe differences in PEEP application and lung function. The study includes patients who are intubated within 24 hours and expected to need mechanical ventilation for at least 48 hours. The total participation period depends on clinical course, with catheter removal at extubation or day 28 and ongoing safety monitoring.

Researchers are evaluating the best post-operative care for females who have previously had breast surgery and radiation and are now undergoing repeat breast surgery. These patients are at a higher risk of wound complications such as surgical site infections, dehiscence, and skin necrosis after surgery. The study aims to determine whether post-operative interventions can reduce these early wound complications in this group, as current guidelines are limited and previous studies suggest potential benefits from such treatments. The study is an unblinded randomized controlled trial with three groups. One group will receive the standard care with no additional intervention, the second group will be treated with a one-week course of the oral antibiotic TMP-SMX DS after surgery, and the third group will have a negative pressure wound dressing (ciNPT dressing) applied to the incision for seven days post-operatively. These treatments are being compared to see which approach best reduces wound problems after repeat breast surgery. Participants will be female patients older than 18 years who have had prior breast surgery and radiation and require repeat surgery. They will be followed up at 1-2 weeks and again at 4-6 weeks after surgery to assess wound healing and complications. Researchers will monitor wound complications including infections, skin breakdown, and necrosis. They will also track any side effects from antibiotics or the wound dressing, additional antibiotic use, re-operations, or hospital admissions. The primary outcome is the rate of wound complications measured 14 days after surgery during follow-up visits.