Key Message

• There is a lack of evidence on the clinical effectiveness of chlorhexidine gluconate wipes for patients being prepped for urinary catheter insertion in acute or community care. More research in this area is needed.
• In critical care settings, bathing with chlorhexidine gluconate wipes results in either a reduction or no difference in the risk of infection compared to bathing with soap and water.
• The results from 1 study demonstrated that using chlorhexidine gluconate‒impregnated cloths the night before and morning of admission pre-surgery reduced infections at the site of the prosthetic in patients undergoing total joint arthroplasty when compared to standard soap and water bathing.
• When reported, adverse events associated with chlorhexidine gluconate wipes included mild skin irritation.

Key Message

• Community pharmacist–led medication reviews are widely used in Canada and internationally.
• It has been shown that community pharmacist–led medication reviews can identify medication issues. Broadly speaking, pharmacists feel qualified to deliver this service and, from the few studies that measured patient satisfaction, patients find value in receiving a medication review in a community pharmacy.
• In terms of patient and health system outcomes, community pharmacist–led medication reviews seem to have limited impact. Individuals living with defined chronic conditions, such as diabetes or hypertension, or those living with multiple chronic conditions seem most likely to benefit.
• No studies of cost-effectiveness in the Canadian context were identified.
• A variety of barriers that impact pharmacist-led medication reviews were identified in the literature, including: o limited communication between community pharmacists and prescribers resulting in pharmacists’ recommendations not being implemented o a lack of time on the part of pharmacists o challenges with patient selection.
• Policy interventions that may help alleviate these barriers include: o incentivizing communication and collaboration between pharmacists and prescribers o reducing administrative burden o improving access to patient information o enhancing patient selection by incentivizing service provision for the most medically complex patients.

Key Message

​Strategies to contain the cost of chronic kidney disease (CKD) care and to improve patient outcomes were found across the continuum of care, from prevention and early disease management through later-stage interventions such as conservative management, dialysis, and transplantation. A variety of health system strategies, including funding reform, were identified to help support and enable sustainable CKD care.

For those at risk of CKD or in early stages of the disease, public health interventions to support healthy behaviours and ensure access to primary health care seem crucial to preventing or delaying disease progression.

For later-stage patients requiring renal replacement therapy, enhancing access to transplantation and home-based dialysis has the potential to reduce costs while improving outcomes and quality of life. Conservative management without dialysis is an option for those who may not be good candidates for renal replacement therapy or who wish to choose a less-invasive care option.

From a health system policy perspective, funding reform may be warranted to enhance team-based CKD care with good continuity. Policy-makers should also consider the ways in which improving financial supports for caregivers, providing travel and expense reimbursement for home dialysis patients and living organ donors, and providing support for utility and ancillary costs of home dialysis could incentivize sustainable CKD care.

For later-stage patients requiring renal replacement therapy, enhancing access to transplantation and home-based dialysis has the potential to reduce costs while improving outcomes and quality of life. Conservative management without dialysis is an option for those who may not be good candidates for renal replacement therapy or who wish to choose a less-invasive care option.

From a health system policy perspective, funding reform may be warranted to enhance team-based CKD care with good continuity. Policy-makers should also consider the ways in which improving financial supports for caregivers, providing travel and expense reimbursement for home dialysis patients and living organ donors, and providing support for utility and ancillary costs of home dialysis could incentivize sustainable CKD care.

Key Message

• Evidence from 2 randomized controlled trials and 4 retrospective studies with limited methodological quality suggests that treatment with autologous hematopoietic stem cell transplantation was associated with significant improvement in clinical outcomes (e.g., disease progression, clinical relapse), MRI outcomes, the composite outcome “No Evidence of Disease Activity,” and quality of life compared to disease-modifying therapies.
• Treatment with autologous hematopoietic stem cell transplantation was associated with no treatment-related mortality or life-threatening complications including progressive multifocal leukoencephalopathy. However, autologous hematopoietic stem cell transplantation was associated with expected short-term adverse events including febrile neutropenia, organ infections, sepsis, and viral reactivations; and long-term adverse events including the development of new autoimmune diseases, mainly thyroid disease.
• Both identified guidelines recommend the use of autologous hematopoietic stem cell transplantation as standard of care for the treatment of highly active relapsing-remitting multiple sclerosis patients refractory to disease-modifying therapies and suggest that the treatment may be appropriate for progressive forms of multiple sclerosis with an active inflammatory component.
• No cost-effectiveness studies were identified.

Key Message

• Evidence from 5 systematic reviews, 3 randomized controlled trials, and 4 observational studies provide inconsistent evidence regarding the comparative efficacy and safety of antipsychotic drugs and benzodiazepines for adults with acute aggression or agitation requiring rapid tranquilization in emergency department or mental health inpatient settings.
• Overall, the evidence came from low- to moderate-quality studies. Some studies suggested different antipsychotic drugs and benzodiazepines, alone or in combination, have similar efficacy, whereas others favoured one treatment over another.
• No studies differentiated between adults aged 18 to 64 years and those older than 65 years. Most studies included mixed ages or excluded patients older than 75 years.
• No studies differentiated between aggression or agitation associated with psychiatric illness and other etiologies such as alcohol intoxication.
• One guideline suggests initial treatment with intramuscular lorazepam, promethazine, or 1 of aripiprazole, droperidol, or olanzapine. If the desired outcome is not achieved with monotherapy, the guideline recommends an intramuscular combination of either promethazine plus haloperidol or lorazepam plus haloperidol.

Key Message

Overdose deaths have been occurring at high rates in many parts of Canada. From January 2016 (when national surveillance began) to March 2019, an estimated 12,800 Canadians died of an opioid overdose.1 In addition to opioid-related harms, stimulants such as methamphetamine have re-emerged in some regions and are also contributing to the current rise in overdose deaths.

COVID-19 has resulted in a more compromised illicit drug supply, and those who use drugs have had limited access to formal and informal supports because of public health measures regarding physical distancing. As a result, overdose deaths have increased during the pandemic.

Harm reduction approaches provide a mechanism to prevent overdose deaths and have additional health and public safety benefits. The current crisis has been exacerbated by COVID-19; therefore, it is an appropriate time to consider the entire continuum of harm reduction approaches available to reduce preventable overdose deaths.

People with lived experience of drug use should be meaningfully included in policy discussions about harm reduction and overdose prevention interventions. This would enhance the person-centredness of programs and ensure they are reflective of the lived realities of those who use drugs.

Although societal attitudes about drug use are changing, harm reduction interventions remain politically contentious. Countering stigma, being prepared to engage with community concerns, and clearly articulating that harm reduction services are intended to complement and not replace drug treatment are all important in enhancing public understanding of harm reduction.