ABSTRACT
INTRODUCTION: Recommendations regarding ventilation strategies in the setting of COVID-19, which may culminate in a clinical picture similar to ARDS, have not yet been well established. Prone positioning has shown benefit as an adjunct supportive measure for patients who develop ARDS. However, studies assessing the benefit of prone positioning have excluded patients with reduced intracranial compliance resulting in a unique predicament, whereby patients with concomitant neurological diagnoses and ARDS have no defined treatment algorithm or recommendations for management. METHODS: A systematic review of the literature, performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2009 guidelines, yielded 10 articles for analysis. Utilizing consensus from these articles, in combination with review of multi-institutional proning protocols for patients with non-neurologic conditions, a proning protocol for patients with intracranial pathology and concomitant ARDS was developed. RESULTS: Among the 10 studies included in final analysis, there was consensus that prone positioning should be considered when there is evidence of acute lung injury or ARDS in patients with neurologic injury. Patients may be proned with a speciality bed or manually on a standard bed with the assistance of seven to nine personnel, in the manner described herein. Special consideration for patients requiring frequent neurologic exams and patients at risk of cardiac arrest or seizure are discussed. CONCLUSION: While elevations in ICP and reductions in CPP do occur during proning, they may not occur to a degree that would warrant exclusion of prone ventilation as a treatment modality for patients with ARDS and concomitant neurological diagnoses. In cases where ICP, CPP, and PbtO2 can be monitored, prone-position ventilation should be considered a safe and viable therapy.
ABSTRACT
The drivers of the harassment and intimidation of researchers are complex, widespread, and global in their reach and were being studied across many disciplines even before COVID-19. This policy briefing reviews some of the scholarship on this wide-ranging problem but focuses on what can be done to help ensure that Canadians fully benefit from the work of Canada's researchers while also preserving the security and safety of those researchers. It identifies policies and actions that can be implemented in the near term to gather information on the problem, better frame public research communications, and ensure that mechanisms are readily available to support researchers who are threatened. The policy briefing is concerned with researchers, but these behaviours are also harming journalists, politicians, public health communicators, and many others more fully in the public eye than researchers. Some recommendations here may help to address this wider problem.
ABSTRACT
Post-secondary education (PSE) is a vital part of civil society and any modern economy. When broadly accessible, it can enable socioeconomic mobility, improve health outcomes, advance social cohesion, and support a highly skilled workforce. It yields public benefits not only in improved well-being and economic prosperity, but also in reduced costs in health care and social services. Canada also relies heavily on the PSE sector for research. During the COVID-19 pandemic, PSE has supported research related to the pandemic response and other critical areas, including providing expert advice to support public health and government decision-making, while maintaining educational programs and continuing to contribute to local and regional economies. But the pandemic effort has stretched already strained PSE resources and people even further: for decades, declining public investment has driven increases in tuition and decreases in faculty complement, undermining Canada's research capacity and increasing student debt as well as destabilizing the sector through a growing reliance on volatile international education markets. Given the challenges before us, including climate change, reconciliation, and the pandemic, it is imperative that we better draw on the full range of experience, knowledge, and creativity in Canada and beyond through an inclusive, stable, and globally engaged PSE. Supporting PSE's recovery will be key to Canada's ongoing pandemic response and recovery. The recommendations in this report are guided by a single goal-to make the post-secondary sector a more effective partner and support in building a more equitable, sustainable, and evidence-driven future for Canada, through and beyond the COVID-19 pandemic.