Background: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant multi-organ condition occurring with a 1 in 3800 prevalence in Alberta. This genetic disorder leads to vascular malformations in different organs including the lungs and brain, commonly affecting pulmonary vasculature leading to pulmonary arteriovenous malformations (PAVMs). PAVMs lead to right-to-left shunts, which may be associated with neurologic complications. We aimed to evaluate and summarize the reported neurologic manifestations of individuals with HHT with pre-existing PAVMs. Methods: We performed a qualitative systematic review to determine available literature on neurological complications among patients with PAVMs and HHT. Published studies included observational studies, case studies, prospective studies, and cohort studies including search terms HHT, PAVMs, and various neurologic complications using MEDLINE and EMBASE. Results: A total of 449 manuscripts were extracted including some duplicates of titles, abstracts, and text which were screened. Following this, 23 publications were identified for inclusion in the analysis. Most were case reports (n = 15). PAVMs were addressed in all these articles in association with various neurological conditions ranging from cerebral abscess, ischemic stroke, hemorrhagic stroke, embolic stroke, and migraines. Conclusion: Although HHT patients with PAVMs are at risk for a variety of neurological complications compared to those without PAVMs, the quality and volume of evidence characterizing this association is low. Individuals with PAVMs have a high prevalence of neurological manifestations such as cerebral abscess, transient ischemic attack, cerebral embolism, hemorrhage, and stroke. Mitigating stroke risk by implementing proper standardized screening techniques for PAVMs is invaluable in preventing increased mortality.

Rationale: Asthma is a chronic inflammatory disease of the airways that is very common (7.9% ofCanadians over the age of 12). Despite numerous clinical guidelines, education events and administrativedata reviews, there has been little change to the way asthma is managed in the Canadian health caresystem for nearly 30 years. We evaluated, through the Physician Learning Program (PLP) in Alberta,possible reasons why administrative datasets have not been able to provide meaningful information toadjust health policy. Methods: Provincial data was attained through Alberta Health Service and Alberta Health on pulmonaryfunction testing from 2005-2011 (through the PLP). The number of asthma diagnosis made during the sametime frame were then compared. Results: The preliminary results of the PLP found that spirometry was billed for roughly half as often asthe asthma diagnostic codes were utilized during the same time frame. However, the review also revealedinconsistencies in how administrative data are captured, making it difficult to determine whetherspirometry is being underutilized by physicians in making asthma diagnoses. Conclusions: Inconsistencies in how administrative data are captured in Alberta may be contributingto an incomplete picture of the rates of asthma diagnosis and physiological testing, and may explain, inpart, the limited influence of administrative datasets on guiding meaningful change within the healthcaresystem.

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