Paraplegia affected 14 hedgehogs (Erinaceus europaeus) in a wildlife rescue hospital over a period of six months. Postmortem examination revealed demyelination in the brain and spinal cord and an inflammatory response in the meninges, choroid plexus and CNS. The peripheral nervous system was not affected. In the spleen, lungs and liver there was an accumulation of megakaryocytes and other evidence of extramedullary haemopoiesis, but there was no haematological evidence of anaemia. The pattern of disease incidence and the nature of the changes in the CNS suggest they were of viral origin, but no causal agent was isolated and the possibility of a neurotoxin cause cannot be ruled out.

A four-year-old wire-haired dachshund developed progressive neurological signs of ataxia, intention tremor and finally dysuria. Two years later, histopathology showed that neurons throughout the brain and spinal cord were distended with lipopigment which was also present in macrophages. Ultrastructurally, the pigment in the neurons occurred predominantly as electron-dense membranous whorls and stacks. There were a few vacuolated macrophages in the meninges. Hepatocytes were highly vacuolated and electron microscopy suggested that they were empty membrane-bound vesicles. The disease was diagnosed as mucopolysaccharidosis IIIA because of its similarity to other biochemically confirmed cases in the same breed and in a New Zealand huntaway dog. Additional lesions included calcium oxalate uroliths, severe secondary calcification of tissues including the brain and storage deposits in some neurons, and lesions which may have been associated with high levels of the substrate, heparan sulphate.

For chronic pain, 1 hub-and-spoke model and 4 stepped care models for the delivery of care in Canada and internationally were identified and described. No information was found on the use of the Oncology Care Model for chronic pain. For other medical conditions, 9 stepped care models, 5 hub-and-spoke models, and the Oncology Care Model for the delivery of care in Canada and internationally were identified and described. Patient-related outcomes used to evaluate the effectiveness of models of care for chronic pain include pain measures (e.g., intensity, duration), psychosocial outcomes (e.g., anxiety, depression), functional outcomes (e.g., disability, employment status), and health care utilization (e.g., opioid prescriptions, health care visits). Various barriers and facilitators to providing care for patients with chronic pain were identified in the consultations and the literature. The most common factors that influenced the care provided to patients with chronic pain pertained to funding, support, and collaboration from the government and locally; having a centralized intake and referral system; and leveraging existing resources. There appears to be considerable variation in the models of care used to address the care needs of patients with chronic pain. In Canada, there are provincial, regional, and local models, and local programs; some regions do not have a formalized approach for the provision of care for chronic pain patients.

Remote monitoring is a type of telehealth whereby health care is delivered to patients outside traditional settings by allowing health data to be exchanged between patients and health care providers using telecommunication techniques (e.g., video conferencing) or stand-alone devices (e.g., portable heart rate monitors). The goals of remote monitoring centre around promoting home-based self-management to improve patient outcomes and/or reduce health system usage. CADTH’s Health Technology Assessment included the following analyses: A Realist Review: This sought to identify key perceived or actual mechanisms of remote monitoring programs. Substantial evidence was available regarding the use of remote monitoring programs for heart failure (n = 64) and cardiac rehabilitation (n = 23), limited evidence was available for atrial fibrillation (n = 4), and none was available for hypertension. A Perspectives and Experiences Review: This thematic synthesis of primary qualitative research sought to understand and describe peoples’ experiences with and perspectives on remote monitoring programs for cardiac conditions. CADTH also engaged patients and caregivers directly in a patient engagement section. An Ethics Review: This sought to identify and reflect upon key ethical issues that should be considered when contemplating the implementation of remote monitoring programs. Overall, the vast majority of sampled patients, caregivers, and health professionals consistently found or perceived remote monitoring programs across different cardiac conditions to be easy to use and beneficial to health. Remote monitoring programs may be an attractive adjunct as opposed to an alternative to existing health professionals and services. Although remote monitoring programs may ultimately reduce avoidable hospitalizations, they may increase net costs and workload during set-up and operational phases without careful pathway design and expectations management. More research is needed to identify the costs and cost-effectiveness of remote monitoring programs across chronic cardiac conditions.

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