Use of Novel Strategies to Develop Guidelines for Management of Pyogenic Osteomyelitis in Adults: A WikiGuidelines Group Consensus Statement.

Importance Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence. Objective To construct a clinical guideline for pyogenic osteomyelitis management, with a new standard of evidence to resolve the gap between strength of recommendation and quality of evidence, through the use of a novel open access approach utilizing social media tools. Evidence Review This consensus statement and systematic review study used a novel approach from the WikiGuidelines Group, an open access collaborative research project, to construct clinical guidelines for pyogenic osteomyelitis. In June 2021 and February 2022, authors recruited via social media conducted multiple PubMed literature searches, including all years and languages, regarding osteomyelitis management; criteria for article quality and inclusion were specified in the group's charter. The GRADE system for evaluating evidence was not used based on previously published concerns regarding the potential dissociation between strength of recommendation and quality of evidence. Instead, the charter required that clear recommendations be made only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were drafted to discuss pros and cons of care choices. Both clear recommendations and clinical reviews were planned with the intention to be regularly updated as new data become available. Findings Sixty-three participants with diverse expertise from 8 countries developed the group's charter and its first guideline on pyogenic osteomyelitis. These participants included both nonacademic and academic physicians and pharmacists specializing in general internal medicine or hospital medicine, infectious diseases, orthopedic surgery, pharmacology, and medical microbiology. Of the 7 questions addressed in the guideline, 2 clear recommendations were offered for the use of oral antibiotic therapy and the duration of therapy. In addition, 5 clinical reviews were authored addressing diagnosis, approaches to osteomyelitis underlying a pressure ulcer, timing for the administration of empirical therapy, specific antimicrobial options (including empirical regimens, use of antimicrobials targeting resistant pathogens, the role of bone penetration, and the use of rifampin as adjunctive therapy), and the role of biomarkers and imaging to assess responses to therapy. Conclusions and Relevance The WikiGuidelines approach offers a novel methodology for clinical guideline development that precludes recommendations based on low-quality data or opinion. The primary limitation is the need for more rigorous clinical investigations, enabling additional clear recommendations for clinical questions currently unresolved by high-quality data

Percutaneous revascularization for ischemic left ventricular dysfunction: Cost-effectiveness analysis of the REVIVED-BCIS2 trial

BACKGROUND: Percutaneous coronary intervention (PCI) is frequently undertaken in patients with ischemic left ventricular systolic dysfunction. The REVIVED (Revascularization for Ischemic Ventricular Dysfunction)-BCIS2 (British Cardiovascular Society-2) trial concluded that PCI did not reduce the incidence of all-cause death or heart failure hospitalization; however, patients assigned to PCI reported better initial health-related quality of life than those assigned to optimal medical therapy (OMT) alone. The aim of this study was to assess the cost-effectiveness of PCI+OMT compared with OMT alone. METHODS: REVIVED-BCIS2 was a prospective, multicenter UK trial, which randomized patients with severe ischemic left ventricular systolic dysfunction to either PCI+OMT or OMT alone. Health care resource use (including planned and unplanned revascularizations, medication, device implantation, and heart failure hospitalizations) and health outcomes data (EuroQol 5-dimension 5-level questionnaire) on each patient were collected at baseline and up to 8 years post-randomization. Resource use was costed using publicly available national unit costs. Within the trial, mean total costs and quality-adjusted life-years (QALYs) were estimated from the perspective of the UK health system. Cost-effectiveness was evaluated using estimated mean costs and QALYs in both groups. Regression analysis was used to adjust for clinically relevant predictors. RESULTS: Between 2013 and 2020, 700 patients were recruited (mean age: PCI+OMT=70 years, OMT=68 years; male (%): PCI+OMT=87, OMT=88); median follow-up was 3.4 years. Over all follow-ups, patients undergoing PCI yielded similar health benefits at higher costs compared with OMT alone (PCI+OMT: 4.14 QALYs, £22 352; OMT alone: 4.16 QALYs, £15 569; difference: −0.015, £6782). For both groups, most health resource consumption occurred in the first 2 years post-randomization. Probabilistic results showed that the probability of PCI being cost-effective was 0. CONCLUSIONS: A minimal difference in total QALYs was identified between arms, and PCI+OMT was not cost-effective compared with OMT, given its additional cost. A strategy of routine PCI to treat ischemic left ventricular systolic dysfunction does not seem to be a justifiable use of health care resources in the United Kingdom

Arrhythmia and death following percutaneous revascularization in ischemic left ventricular dysfunction: Prespecified analyses from the REVIVED-BCIS2 trial

BACKGROUND: Ventricular arrhythmia is an important cause of mortality in patients with ischemic left ventricular dysfunction. Revascularization with coronary artery bypass graft or percutaneous coronary intervention is often recommended for these patients before implantation of a cardiac defibrillator because it is assumed that this may reduce the incidence of fatal and potentially fatal ventricular arrhythmias, although this premise has not been evaluated in a randomized trial to date. METHODS: Patients with severe left ventricular dysfunction, extensive coronary disease, and viable myocardium were randomly assigned to receive either percutaneous coronary intervention (PCI) plus optimal medical and device therapy (OMT) or OMT alone. The composite primary outcome was all-cause death or aborted sudden death (defined as an appropriate implantable cardioverter defibrillator therapy or a resuscitated cardiac arrest) at a minimum of 24 months, analyzed as time to first event on an intention-to-treat basis. Secondary outcomes included cardiovascular death or aborted sudden death, appropriate implantable cardioverter defibrillator (ICD) therapy or sustained ventricular arrhythmia, and number of appropriate ICD therapies. RESULTS: Between August 28, 2013, and March 19, 2020, 700 patients were enrolled across 40 centers in the United Kingdom. A total of 347 patients were assigned to the PCI+OMT group and 353 to the OMT alone group. The mean age of participants was 69 years; 88% were male; 56% had hypertension; 41% had diabetes; and 53% had a clinical history of myocardial infarction. The median left ventricular ejection fraction was 28%; 53.1% had an implantable defibrillator inserted before randomization or during follow-up. All-cause death or aborted sudden death occurred in 144 patients (41.6%) in the PCI group and 142 patients (40.2%) in the OMT group (hazard ratio, 1.03 [95% CI, 0.82–1.30]; P =0.80). There was no between-group difference in the occurrence of any of the secondary outcomes. CONCLUSIONS: PCI was not associated with a reduction in all-cause mortality or aborted sudden death. In patients with ischemic cardiomyopathy, PCI is not beneficial solely for the purpose of reducing potentially fatal ventricular arrhythmias. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01920048

"Cripping" Resilience: Generating New Vocabularies of Resilience from Narratives of Post-secondary Students Who Experience Disability

This study is an exploration into the kinds of meanings embedded in dominant conceptions of resilience, and the ways such conceptions may be deployed, shaped, and reshaped through an encounter with “disability.” The purpose of this project is to critique, deepen and expand on existing understandings of resilience through the storied accounts of 14 post-secondary students in Alberta who experience disability. Robert McRuer’s Crip Theory, and other scholarship in critical disability studies, assists in the identification of critiques and in proposing alternative meanings of resilience (referred to in this study as “cripping” resilience). New vocabularies of resilience, emerging from three kinds of narratives (Narrative of Movement, Complicating Narrative, and Narrative of (Re)imagination), are proposed to more realistically reflect the life experiences, meaning constructions, and (dis)identities of people who experience disability. Lastly, new vocabularies of resilience and new theoretical treatments suggest avenues for crafting more accessible university settings

Deconstructing the Resilience Concept Using an Ableism Lens: Implications for People with Diverse Abilities

The following paper explores existing conceptualizations of resilience (namely, the ecological approach and the constructionist approach) as they apply to ability-diverse people. The concept of ableism (hegemonic ability preferences which inaugurate the norm) is presented and is demonstrated to be of utility as an analytical lens. Findings suggest an ecological approach to resilience is problematic for the advancement of disabled people�s rights. Specifically, the presence of ableist assumptions and language demonstrate a continued need for critical examination of an ecological understanding of resilience and its capacity to incorporate ability-diversity. We suggest that a feminist ethics of care contributes to a less oppressive understanding of resilience amongst people with diverse abilities. Findings are highly anticipated to address existing literature gaps, and to be of importance to policymakers, researchers, and ability-diverse populations.El presente trabajo explora las conceptualizaciones actuales de la capacidad de resistencia que se aplican a personas con habilidades-diversas. El concepto de �ableísmo� es presentado y se demuestra su utilidad como un lente analítico. Los resultados indican que un enfoque ecológico a la capacidad de resistencia representa un problema para el avance de los derechos de las personas con habilidades diversas. En concreto, la presencia de asunciones y lenguaje �ableístas� demuestran una continua necesidad de examen crítico de las políticas relacionadas con la capacidad de resistencia y su capacidad para incorporar a la población con habilidades diversas. Sugerimos que una ética feminista del cuidado de personas con habilidades diversas contribuye a la comprensión de la capacidad de resiliencia, promoviendo una agenda positiva de los derechos de las personas con habilidades diversas y dando una dirección positiva para políticas en esta área. Los resultados seguramente ayudaran a hacer frente a las lagunas existentes en la literatura de este tema, y serán de gran importancia para los responsables de políticas, investigadores, y la población con habilidades diversas

Alberta Incidence Study of Reported Child Abuse and Neglect-2008 (AIS-2008): Major Findings

The Alberta Incidence Study of Reported Child Abuse and Neglect‑2008 (AIS‑2008) is the second province‑wide study to examine the incidence of reported child maltreatment and the characteristics of the children and families investigated by Alberta child intervention offices. The AIS‑2008 tracked 2,239 child maltreatment investigations conducted in a representative sample of 14 Child Intervention Service offices across Alberta in the fall of 2008.The AIS‑2008 research was funded by: Government of Alberta Children and Youth Services, and the Injury and Child Maltreatment Section, Public Health Agency of Canada. Additional support was provided by the University of Calgary, Faculty of Social Work

British Columbia Incidence Study of Reported Child Abuse and Neglect - 2008 (BCIS-2008)

Non‑commercial reproduction of this report in whole or in part is permitted, provided the authors are acknowledged as the source of all copies.The Public Health Agency of Canada provided core funding for the British Columbia Incidence Study of Reported Child Abuse and Neglect‑2008 (BCIS‑2008). Additional provincial oversampling funds were provided by the Government of British Columbia, Ministry of Children and Family Development

Saskatchewan Incidence Study of Reported Child Abuse and Neglect-2008 (SIS‑2008): Major Findings

Non‑commercial reproduction of this report in whole or in part is permitted, provided the authors are acknowledged as the source of all copies.The following report presents the major descriptive findings from the Saskatchewan Incidence Study of Reported Child Abuse and Neglect (SIS‑2008). The SIS‑2008 is the first province-wide study to examine the incidence of reported child maltreatment and the characteristics of the children and families investigated by child welfare services in Saskatchewan. The estimates presented in this report are primarily based on information collected from child welfare investigators on a representative sample of 8,933 child welfare investigations conducted across Saskatchewan.The SIS‑2008 research was funded by: Government of Saskatchewan Ministry of Social Services, and the Injury and Child Maltreatment Section, Public Health Agency of Canada. Additional support was provided by the University of Calgary, Faculty of Social Work