Key Message

Patient portals allow users to access, manage, and share their health information online.Patient portals are available in 6 provinces: Alberta, British Columbia, Saskatchewan, Ontario, Prince Edward Island, and Quebec. Patient portals in Canada are implemented at the provincial, regional, or clinic level of the health care system, and vary in the health data and features that are shared with users. Medical imaging reports are shared on portals in Alberta, Ontario, Quebec, and Saskatchewan. In Saskatchewan and Alberta, reports are available immediately, whereas Quebec has a 30-day embargo period. Ontario has an intention to enable patient portals to share medical images from provincial diagnostic imaging repositories in the future. A tailored approach may be considered when timing the release of medical imaging results due to concerns related to patient anxiety, especially for individuals waiting for diagnostic results of potentially life-threatening or serious conditions. Radiologists can use lay language in their reports and provide users with reliable sources of information to increase understanding of complex results. They may develop or take advantage of existing patient-friendly templates for sharing results on portals.

Key Message

"We found that electrostimulation as an adjunct to usual wound care might be better than usual care alone for wound management without increasing the risk of adverse events.Electrostimulation therapy may have greater effectiveness for patients with chronic wounds versus acute wounds or those with venous leg ulcers (VLUs) who do not have surgery compared with those who do have surgery. Electrostimulation using pulsed current may have greater effectiveness on wound management than using direct current for patients with pressure ulcers. Limited evidence from subgroup analyses suggests that the effectiveness of electrostimulation may be similar to negative pressure wound therapy (NPWT) in wound surface area (WSA) and time to complete wound healing. One economic evaluation study used a within-trial time horizon (up to 24 weeks) and, based on the UK National Health Service perspective, suggests that electrostimulation is less costly and more effective than placebo at 24 weeks. We did not find any studies reporting on the cost-effectiveness between electrostimulation and NPWT that met the inclusion criteria for this report. One guideline suggests using electrostimulation as an adjunct intervention for managing postoperative pain in patients who have undergone elective caesarean section; another guideline strongly recommends against physical therapies (including electrostimulation) for diabetic foot ulcer management. A patient with lived experience of using an electrostimulation device for the treatment of a wound was involved in this report. He identified outcomes that are important to patients, primarily avoiding hospitalization and surgery, which were not outcomes reported in the identified literature. Considerations included the accessibility of the devices, training, and integration into homecare services."

Key Message

Dual point-of-care tests for HIV and syphilis and standalone point-of-care tests for syphilis may be useful in prenatal care for screening people for potential HIV and/or syphilis infections, based on findings from test accuracy studies. In prenatal care, point-of-care tests for syphilis have the potential to be cost-effective and may increase the proportion of people screened and treated for syphilis. Decision-makers should consider the potential for point-of-care HIV and syphilis screening to increase access to timely treatment for birthing parents and newborns, particularly in rural and remote communities and certain equity-deserving groups. However, the identified studies for this report provided few details about included populations, limiting an assessment of potential health inequities related to point-of-care screening. None of the included studies used point-of-care tests for HIV or syphilis in people in labour. We did not find any studies on the clinical utility or cost-effectiveness of dual point-of-care tests for HIV and syphilis that met our inclusion criteria. We did not find any studies on the diagnostic test accuracy, clinical utility, or cost-effectiveness of standalone point-of-care tests for HIV that met our inclusion criteria.

Key Message

Findings from systematic reviews describing comparative clinical evidence for platelet-rich plasma injections (PRPis) in the treatment of chronic tendinopathies of the lower extremities were mixed. The systematic reviews we identified were often unclear concerning the components or treatment protocols used in the administration of PRPi, which may have contributed to the lack of a clear demonstration of effect. The variety of patient populations, comparisons, and outcomes in the included systematic reviews may also have contributed to the mixed findings. The lack of a clear demonstration of the comparative clinical effectiveness of PRPi in chronic tendinopathies of the lower extremities does not currently support decision-making in favour of its use.

Key Message

• Treatment with riluzole may provide clinical benefits for patients with amyotrophic lateral sclerosis, including longer survival time, reduced risk of disease progression, and minor reversible adverse events, compared to no treatment with riluzole or a placebo.
• We did not find any studies meeting our selection criteria on the clinical effectiveness of riluzole for patients with amyotrophic lateral sclerosis compared to alternative pharmacological therapies.
• Riluzole may be cost-effective at generic drug costs for patients with amyotrophic lateral sclerosis. Evidence supporting this finding is limited, and further research is required to inform decision-making.
• Riluzole is recommended for the treatment of amyotrophic lateral sclerosis, except for patients with progressive muscular atrophy, primary lateral sclerosis, or hereditary spastic paraplegia, and should be initiated promptly following disease diagnosis.
• A patient with lived experience of riluzole treatment for amyotrophic lateral sclerosis was involved in this report. They identified outcomes that are important to patients, including slowing the progression of amyotrophic lateral sclerosis and minimal side effects from the medication.

Key Message

We did not find any evidence regarding the clinical effectiveness and safety of alternative treatments to IV Immunoglobulin (IVIG) compared to IVIG or placebo for idiopathic inflammatory myopathies (IIM) that met our inclusion criteria for this review. Three evidence-based guidelines provide recommendations regarding IVIG and other drugs to manage IIM. However, we did not find any recommendations regarding alternative treatments to IVIG specifically. Rituximab may be considered as another option to IVIG to treat IIM-related skeletal muscle inflammation (1 guideline) or skin manifestations (1 guideline) resistant to treatment with steroids. In juvenile IIM, rituximab or IVIG can be used as adjunct care in case of treatment failure.

Key Message

For chronic wound care, the majority of evidence suggested that antiseptic agents do not add additional clinical benefits compared with saline. No differences were observed between antiseptics and saline in the incidence of adverse events. For surgical wound care, irrigation with antibiotic agents is likely associated with lower rates of surgical site infections compared with saline irrigation. Depending on the type of antiseptic agent, type of surgery, and depth of infection, antiseptic irrigation may have superior or similar efficacy compared with saline in surgical site infection and wound healing rates. Indirect evidence suggested antibiotics were not superior to antiseptics for prevention of surgical site infections. No differences were observed between antiseptic irrigation and saline irrigation in the incidence of adverse events and length of hospital stay. For acute traumatic wound care, a limited number of studies provided mixed results on the effectiveness of povidone-iodine compared with saline for preventing infection. The effect of antiseptic agents on bacterial load was unclear. No robust conclusions could be drawn due to very low certainty of the evidence. The economic evaluation study showed that irrigation with hypochlorous acid preserved wound cleanser was a cost-effective strategy in the short term compared with saline for the treatment of severely complex wounds during ultrasonic debridement. However, we have little confidence in the findings due to several limitations in the methods of the study. We did not identify any studies that compared the clinical effectiveness and cost-effectiveness of antimicrobial or antiseptic wound cleansers with antimicrobial dressings or of different types of antimicrobial or antiseptic wound cleansers for the management of wounds. We did not identify any evidence-based guidelines regarding the use of antimicrobial or antiseptic wound cleansers for the management of wounds.

Key Message

Death by suicide is the second-leading cause of death for young people in Canada. Because 10% to 15% of the people seen in hospital emergency departments for a suicide attempt will repeat the attempt within 12 months following their discharge, it is important to identify what interventions are effective for preventing further self-harm during this time. Active follow-up care following an emergency department visit for a suicide attempt is common; however, it is unclear what type (e.g., text message, home visit) or timing (e.g., 24 hours, within 72 hours after emergency department discharge) of interventions is most effective for preventing further self-harm in people younger than 18 years. The objective of this review is to summarize the evidence regarding the clinical effectiveness of active contact and follow-up interventions, and the timing and duration of care, for children and adolescents (younger than 18 years) who present to emergency care for suicide attempts or suicide ideations. For children and adolescents presenting to the emergency department for suicide attempts or ideation, telephone-based follow-up care initiated within 1 week of discharge may not affect the number of people who completed the full course of postdischarge treatment, the mean number of sessions attended, or the number of suicide deaths. This finding was based on evidence from 2 systematic reviews, each with 1 primary study relevant to this report. The small sample sizes of these studies (N = 64 and N = 97) and their limited or unclear quality should be considered when interpreting these results. None of the relevant primary studies within the systematic reviews reported on mental health outcomes (e.g., depression, social functioning) or harms from the intervention. No studies were found that evaluated the clinical effectiveness of other methods of active follow-up care or of different time durations of follow-up care for children and adolescents who present to emergency care for suicide attempts or suicide ideations that met our criteria for this review. No evidence-based guidelines were identified that provided recommendations about timing, modality, and which health care professionals should be involved in follow-up care for children and adolescents who present to emergency care for suicide attempts or ideations that met our criteria for this review. Guidance documents and guidelines for adults generally recommend that follow-up should occur within 48 hours, particularly for those with safety concerns of subsequent self-harm. These guidance documents also suggest different modalities for follow-up during that time, including telephone calls, visits, and electronic communication. Given the higher risk and potential vulnerability experienced by children and adolescents and the absence of formal clinical guidelines, person-centred follow-up care for all children and adolescents within 48 hours should be considered, similar to adults who present with high concerns.