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Reports that a physician involved in an Israeli assassination attempt in Jordan was carrying a forged Canadian passport.

The article discusses the sanctions of scientists to speak freely abut their works by the Liberal government of Canada. It notes the 2013 survey of trade union Professional Institute of the Public Service of Canada (PIPSC) which reported the highest rates of interference by management with manuscripts and conference presentations among members of government department Health Canada. It also notes the call of PIPSC and Evidence for Democracy for a legacy of draconian communication policies.

Presents information on the planned introduction of reduced ignition propensity (RIP) cigarettes in Canada by 2005. Market reach of Merit, the first RIP cigarette in the world manufactured by Philip Morris; Statistics on fires caused by careless smoking in Canada, as of 2003; Objection regarding the level of toxicity of RIP cigarettes.

This article reports on the discussion paper, It's About Access! Informing the Debate on Public and Private Health Care, which was released by the Canadian Medical Association (CMA). Attendees at the CMA Annual Meeting will be asked to use the discussion paper to address the split between the private and public health care. The possible scenarios for the changes in the Canadian health care system are highlighted. The paper was co-authored by Dr. Robert Hollinshead.

Clark Noble was one of the first members of the University of Toronto insulin team and came within a coin toss of replacing Charles Best as Frederick Banting's assistant during the summer of 1921. Noble performed important early studies helping to characterize insulin's action, and he co-authored many of the original papers describing insulin. Because mass production of insulin from livestock pancreata had proved elusive throughout 1922, J.J.R. Macleod hired Noble during the summer of 1923 to help him test and develop a new method for producing commercial quantities of insulin that Macleod believed would revolutionize insulin production. However, commercial production of insulin from fish proved impractical and was dropped by 1924, as methods to produce large quantities of mammalian insulin had improved very rapidly. Noble later played a small but critical role in the most important Canadian contribution to cancer chemotherapy research: the discovery of vinca alkaloids by his brother Robert Laing Noble. Although one might expect that a physician involved in 2 of Canada's most important medical discoveries during the 20th century must be famous, such was not Clark Noble's fate. He died without so much as an obituary in CMAJ. INSET: From our files. [ABSTRACT FROM AUTHOR]

Background: Canada's health care systems underserve people who are transgender and gender diverse (TGD), leading to unique disparities not experienced by other patient groups, such as in accessing gender-affirmation surgery. We sought to explore the experiences of TGD people seeking and accessing gender-affirmation surgery at a publicly funded hospital in Canada to identify opportunities to improve the current system. Methods: We used hermeneutic phenomenology according to Max van Manen to conduct this qualitative study. Between January and August 2022, we conducted interviews with TGD people who had undergone penile-inversion vaginoplasty at Women's College Hospital, Toronto, Ontario, since June 2019. We conducted interviews via Microsoft Teams and transcribed them verbatim. We coded the transcripts using NVivo version 12. Using inductive analysis, we constructed themes, which we mapped onto van Manen's framework of lived body, lived time, lived space, and lived human relations. Results: We interviewed 15 participants who had undergone penile-inversion vaginoplasty; they predominantly self-identified as transgender women (n = 13) and White (n = 14). Participants lived in rural (n = 4), suburban (n = 5), or urban (n = 6) locations. Their median age was 32 (range 27–67) years. We identified 11 themes that demonstrated the interconnected nature of TGD peoples' lived experiences over many years leading up to accessing gender-affirmation surgery. These themes emphasized the role of the body in experiencing the world and shaping identity, the lived experience of the body in shaping human connectedness, and participants' intersecting identities and emotional pain (lived body); participants' experiences of the passage of time and progression of events (lived time); environments inducing existential anxiety or fostering affirmation, the role of technology in shaping participants' understanding of the body, and the effect of liminal spaces (lived space); and finally, the role of communication and language, empathy and compassion, and participants' experiences of loss of trust and connection (lived human relations). Interpretation: Our findings reveal TGD patients' lived experiences as they navigated a lengthy and often difficult journey to penile-inversion vaginoplasty. They suggest a need for improved access to gender-affirmation surgery by reducing wait times, increasing capacity, and improving care experiences. [ABSTRACT FROM AUTHOR]

Background: Understanding the complex interaction of risk factors that increase the likelihood of developing common diseases is challenging. The Canadian Partnership for Tomorrow Project (CPTP) is a prospective cohort study created as a population-health research platform for assessing the effect of genetics, behaviour, family health history and environment (among other factors) on chronic diseases.Methods: Volunteer participants were recruited from the general Canadian population for a confederation of 5 regional cohorts. Participants were enrolled in the study and core information obtained using 2 approaches: attendance at a study assessment centre for all study measures (questionnaire, venous blood sample and physical measurements) or completion of the core questionnaire (online or paper), with later collection of other study measures where possible. Physical measurements included height, weight, percentage body fat and blood pressure. Participants consented to passive follow-up through linkage with administrative health databases and active follow-up through recontact. All participant data across the 5 regional cohorts were harmonized.Results: A total of 307 017 participants aged 30-74 from 8 provinces were recruited. More than half provided a venous blood sample and/or other biological sample, and 33% completed physical measurements. A total of 709 harmonized variables were created; almost 25% are available for all participants and 60% for at least 220 000 participants.Interpretation: Primary recruitment for the CPTP is complete, and data and biosamples are available to Canadian and international researchers through a data-access process. The CPTP will support research into how modifiable risk factors, genetics and the environment interact to affect the development of cancer and other chronic diseases, ultimately contributing evidence to reduce the global burden of chronic disease. [ABSTRACT FROM AUTHOR]

Background: The Patented Medicine Prices Review Board (PMPRB), the agency that regulates the prices of patented medicines in Canada, published proposed amendments to the regulatory framework in December 2017. Because of a series of changes and delays, the revised policy has not yet been finalized. We sought to evaluate the potential early impact of the uncertainty about the PMPRB policy on patented-medicine launches. Methods: We developed a retrospective cohort of patented medicines (molecules) sold in Canada and the 13 countries that the PMPRB currently uses or has proposed to use as price comparators, from sales data from the IQVIA MIDAS database for 2012–2021. The outcome was whether a molecule was launched (i.e., sold) in a specific country within 2 years of its global first launch (2-yr launch). We compared the change of 2-year launch before (2012–2017) and after the proposed amendments were published ("uncertain period," 2018–2021) in Canada with the change in the United States and the other 12 countries as a group ("other-countries group"), using interrupted time series and logistic regressions, respectively. We further conducted analyses for each individual country and subgroups by molecule characteristics, such as therapeutic benefit, separately. Results: We included 242 and 107 new molecules launched before publication of the proposed amendments and during the uncertain period, respectively. The corresponding 2-year launch proportions were 45.0% and 30.8% in Canada, 81.4% and 82.2% in the US, and 83.9% and 70.1% in the other-countries group. All analyses showed changes in 2-year launch during the uncertain period in the US and in the other-countries group that were similar to the changes in Canada. Greater decreases were observed in Norway and Sweden than in Canada. The 2-year launch proportion for molecules with major therapeutic benefit decreased from 45.8% to 31.3% in Canada during the uncertain period and from 87.5% to 62.5% in the other-countries group, but increased from 91.7% to 100% in the US. Interpretation: No negative impact of the PMPRB-policy uncertainty on molecule launches was observed when comparing Canada with price-comparator countries, except for molecules with major therapeutic benefit. The reduction in launches of medicines with major therapeutic benefit in Canada requires continuing investigation. [ABSTRACT FROM AUTHOR]

Background: Through medicare, residents in Canada are entitled to medically necessary physician services without paying out of pocket, but still many people struggle to access primary care. We conducted a survey to explore people's experience with and priorities for primary care. Methods: We conducted an online, bilingual survey of adults in Canada in fall 2022. We distributed an anonymous link through diverse channels and a closed link to 122 053 people via a national public opinion firm. We weighted completed responses to mirror Canada's population and adjusted for sociodemographic characteristics using regression models. Results: We analyzed 9279 completed surveys (5.9% response rate via closed link). More than one-fifth of respondents (21.8%) reported having no primary care clinician, and among those who did, 34.5% reported getting a same or next-day appointment for urgent issues. Of respondents, 89.4% expressed comfort seeing another team member if their doctor recommended it, but only 35.9%, 9.5%, and 12.4% reported that their practice had a nurse, social worker, or pharmacist, respectively. The primary care attribute that mattered most was having a clinician who "knows me as a person and considers all the factors that affect my health." After we adjusted for respondent characteristics, people in Quebec, the Atlantic region, and British Columbia had lower odds of reporting a primary care clinician than people in Ontario (adjusted odds ratio 0.30, 0.33, and 0.39, respectively; p < 0.001). We also observed large provincial variations in timely access, interprofessional care, and walk-in clinic use. Interpretation: More than 1 in 5 respondents did not have access to primary care, with large variation by province. Reforms should strive to expand access to relationship-based, longitudinal care in a team setting. [ABSTRACT FROM AUTHOR]

Background: Variations in primary care practices may explain some differences in health outcomes during the COVID-19 pandemic. We sought to evaluate the characteristics of primary care practices by the proportion of patients unvaccinated against SARS-CoV-2. Methods: We conducted a population-based, cross-sectional cohort study using linked administrative data sets in Ontario, Canada. We calculated the percentage of patients unvaccinated against SARS-CoV-2 enrolled with each comprehensive-care family physician, ranked physicians according to the proportion of patients unvaccinated, and identified physicians in the top 10% (v. the other 90%). We compared characteristics of family physicians and their patients in these 2 groups using standardized differences. Results: We analyzed 9060 family physicians with 10 837 909 enrolled patients. Family physicians with the largest proportion (top 10%) of unvaccinated patients (n = 906) were more likely to be male, to have trained outside of Canada, to be older, and to work in an enhanced fee-for-service model than those in the remaining 90%. Vaccine coverage (≥ 2 doses of SARS-CoV-2 vaccine) was 74% among patients of physicians with the largest proportion of unvaccinated patients, compared with 87% in the remaining patient population. Patients in the top 10% group tended to be younger and live in areas with higher levels of ethnic diversity and immigration and lower incomes. Interpretation: Primary care practices with the largest proportion of patients unvaccinated against SARS-CoV-2 served marginalized communities and were less likely to use team-based care models. These findings can guide resource planning and help tailor interventions to integrate public health priorities within primary care practices. [ABSTRACT FROM AUTHOR]

Recent expansion of the molecular diagnostics industry has revealed weaknesses in Canada's regulatory system for laboratory-developed tests, which are not subject to statutory regulations on medical devices. Absent regulation as medical devices, the only controls on test performance are laboratory regulation and accreditation, which are heterogeneous and sometimes flawed and do not necessarily include assessment of test validity, safety and efficacy. Diagnostics developed as "test kits" and sold to laboratories, hospitals and clinics are considered to be in vitro diagnostics devices under Medical Devices Regulation in accordance with the federal I Food and Drugs Act i . [Extracted from the article]

Background: Medical assistance in dying (MAiD) was legalized in Canada in 2016, but coordination of MAiD and palliative and end-of-life care (PEOLC) services remains underdeveloped. We sought to understand the perspectives of health leaders across Canada on the relationship between MAiD and PEOLC services and to identify opportunities for improved coordination. Methods: In this quantitative study, we purposively sampled health leaders across Canada with expertise in MAiD, PEOLC, or both. We conducted semi-structured interviews between April 2021 and January 2022. Interview transcripts were coded independently by 2 researchers and reconciled to identify key themes using content analysis. We applied the PATH framework for Integrated Health Services to guide data collection and analysis. Results: We conducted 36 interviews. Participants expressed diverse views about the optimal relationship between MAiD and PEOLC, and the desirability of integration, separation, or coordination of these services. We identified 11 themes to improve the relationship between the services across 4 PATH levels: client-centred services (e.g., educate public); health operations (e.g., cultivate compassionate and proactive leadership); health systems (e.g., conduct broad and inclusive consultation and planning); and intersectoral initiatives (e.g., provide standard practice guidelines across health care systems). Interpretation: Health leaders recognized that cooperation between MAiD and PEOLC services is required for appropriate referrals, care coordination, and patient care. They identified the need for public and provider education, standardized practice guidelines, relationship-building, and leadership. Our findings have implications for MAiD and PEOLC policy development and clinical practice in Canada and other jurisdictions. [ABSTRACT FROM AUTHOR]

Background: In Canada, only 15% of patients requiring palliative care receive such services in the year before death. We describe health care utilization patterns among home care users in their last 6 months of life to inform care planning for older people with varying mortality risks and evolving care needs as they decline. Methods: Using population health administrative data from Ontario, we performed a retrospective cohort study involving home care clients aged 50 years and older who received at least 1 interRAI (Resident Assessment Instrument) Home Care assessment between April 2018 and September 2019. We report the proportion of clients who used acute care, long-term care, and palliative home care services within 6 months of their assessment, stratified by their predicted 6-month mortality risk using a prognostic tool called the Risk Evaluation for Support: Predictions for Elder-life in their Communities Tool (RESPECT) and vital status. Results: The cohort included 247 377 adults, 11.9% of whom died within 6 months of an assessment. Among decedents, 50.6% of those with a RESPECT-estimated median survival of fewer than 3 months received at least 1 nonphysician palliative home care visit before death. This proportion declined to 38.7% and 29.5% among decedents with an estimated median survival between 3 and 6 months and between 6 and 12 months, respectively. Interpretation: Many older adults in Ontario do not receive any palliative home care before death. Prognostic tools such as RESPECT may improve recognition of reduced life expectancies and palliative care needs of individuals in their final years of life. [ABSTRACT FROM AUTHOR]

The article reports on a discussion paper released by the Patented Medicine Prices Review Board which asks Canadians, physicians, and pharmaceutical companies to review the drug-pricing system in Canada, with the aim of modernizing and simplifying the regulatory framework on patented drug pricing. It highlights statistics which compare the cost of medicines in the country with others. The discussion paper is said to be a part of a consultation process designed to focus drug-pricing problems.

The article discusses image manipulation, a medical laboratory misconduct wherein scientists publish microspic images that do not match the original data. Researchers who manipulate images may face significant consequences which include ending of research career. The number of image manipulation issues has reportedly increased, however there are no definite data as it can be hard to prove that the changes were intentional.

Reports that data from the Canadian Medical Association's (CMA) 2002 Physician Resource Questionnaire indicate that only a small percentage of Canadian physicians use electronic media to store active patient records. Percentage which use a combination of paper and electronic media; Number of physicians who claim that improving how patient information is shared is an important or very important potential benefit of electronic health records.

Background: The prevalence of tuberculosis infection is critical to the design of tuberculosis prevention strategies, yet is unknown in Canada. We estimated the prevalence of tuberculosis infection among Canadian residents born abroad. Methods: We estimated the prevalence of tuberculosis infection by age and year of migration to Canada for people from each of 168 countries by constructing country-specific and calendar year–specific trends for annual risk of infection using a previously developed model. We combined country-specific prevalence estimates with Canadian Census data from 2001, 2006, 2011, 2016 and 2021 to estimate the overall prevalence of tuberculosis infection among foreign-born Canadian residents. Results: The estimated overall prevalence of tuberculosis infection among foreign-born people in Canada was 25% (95% uncertainty interval [UI] 20%–35%) for census year 2001, 24% (95% UI 20%–33%) for 2006, 23% (95% UI 19%–30%) for 2011, 22% (95% UI 19%–28%) for 2016 and 22% (95% UI 19%–27%) for 2021. The prevalence increased with age at migration and incidence of tuberculosis in the country of origin. In 2021, the estimated prevalence of infection among foreign-born residents was lowest in Quebec (19%, 95% UI 16%–24%) and highest in Alberta (24%, 95% UI 21%–28%) and British Columbia (24%, 95% UI 20%–30%). Among all foreign-born Canadian residents with tuberculosis infection in 2021, we estimated that only 1 in 488 (95% UI 185–1039) had become infected within the 2 preceding years. Interpretation: About 1 in 4 foreign-born Canadian residents has tuberculosis infection, but very few were infected within the 2 preceding years (the highest risk period for progression to tuberculosis disease). These data may inform future tuberculosis infection screening policies. [ABSTRACT FROM AUTHOR]

Background: Globally, pharmaceutical companies offer patient support programs in tandem with their products, which aim to enhance medication adherence and patient experience through education, training, support and financial assistance. We sought to identify the proportion and characteristics of such patient support programs in Canada and to describe the nature of supports provided. Methods: We conducted a crosssectional study to identify and characterize all marketed prescription drugs available in Canada as of Aug. 23, 2022, using the Health Canada Drug Product and CompuScript databases. To describe the nature of supports provided, we conducted a content analysis of publicly available patient support program websites and Web-based documents. Using logistic regression, we identified characteristics of drugs associated with having a patient support program including brand-name or branded generic (generic medications with a proprietary name), orphan (medications for rare diseases) or biologic drug status; estimated total cost of prescriptions dispensed at retail pharmacies; and price per unit. Results: Of the 2556 prescription drugs marketed by 89 companies in the study period, 256 (10.0%) had a patient support program in Canada. Many of the 89 drug manufacturers (n = 55, 61.8%) offered at least 1 patient support program, frequently relying on third-party administrators for delivery. Brandname and branded generic medications, biologic agents and drugs with orphan status were more likely to have a patient support program than generic drugs. Compared with drugs priced $1.01–$10.00 per unit, drugs priced $10.01–$100.00 per unit were nearly 8 times more likely to have a patient support program (adjusted odds ratio 7.54, 95% confidence interval 4.07– 14.64). Most sampled patient support programs included reimbursement navigation (n = 231, 90.2%) and clinical case management (n = 223, 87.1%). Interpretation: About 1 in 10 drugs marketed in Canada has a manufacturersponsored patient support program, but these are concentrated around brand-name, branded generic, biologic and high-cost drugs, often for rare diseases. To understand the impact of patient support programs on health outcomes and sustainable access to cost-effective medicines, greater transparency and independent evaluation of patient support programs is necessary. [ABSTRACT FROM AUTHOR]

The article announce the Bruce Squires Award received by the pharmacare researchers Steve Morgan from Canadian Medical Association Journal (CMAJ).

The article discusses how the myth that smoking in enclosed vehicle is 23 times more toxic than in house got circulated without its proper validation. The myth was used by Ontario Medical Association in its report, which led its dissemination in Canada. The use of this myth by other international organizations such as the U.S. Action on Smoking and Health organization further enhanced its credibility. It states that policy related to smoking should be based on accurate information.

Reports a review conducted by the Patented Medicine Prices Review Board on its guidelines on patented drugs pricing in Canada. Percentage increase in the price of all patented drugs in 2004; Background on the board; Frameworks presented by a discussion paper released by the board on March 9, 2005.

The article reports on the call of family physicians to develop medical homes in the U.S. It states that U.S. President Barack Obama has shown interest to fund a medical home to oversee the conditions of chronically ill patients in the country. It cites that joining the agenda is the College of Family Physicians of Canada (CFPC) that released a discussion paper and called on governments to establish a medical home. The move of CFPC is not only intended for ill patients but for every Canadian.

The article provides information on the journal "Revue d'art canadienne/ Canadian Art Review" (RACAR). It cites that the said journal provides scholarly papers about medical aesthetic and anatomy in the 19th century. The journal serves as the Universities Art Association of Canada's publication produced with language variation.

In 2002, Osteoporosis Canada published clinical practice guidelines for the diagnosis and management of osteoporosis. The current paper supplements that guideline and provides a review and synthesis of the current literature on the diagnosis and management of osteoporosis in men. [ABSTRACT FROM AUTHOR]

The Oregon Health Plan (OHP) has been widely heralded as an important innovation in medical care policy and rationing. Oregon's pioneering method of prioritizing funding for health care through systematic and public ranking of medical services has drawn substantial international interest. This paper reviews the experience of the Oregon plan since it began operation in 1994. We argue that widespread misconceptions persist about the significance of the OHP. In particular, there is little evidence that the OHP has operated as a model of explicit rationing. In reality, Oregon has not rationed services, nor has its policy of cutting public coverage for services produced substantial savings. These findings have important implications regarding the desirability and feasibility of adopting a policy of removing items from the list of insured medicare services in Canada. Oregon's experience suggests that drawing the line on medicare coverage would be more difficult and less financially rewarding than advocates claim. [ABSTRACT FROM AUTHOR]

Clinicians are exposed to numerous hypertension guidelines. However, their enthusiasm for these guidelines, and the impact of the guidelines, appears modest at best. Barriers to the successful implementation of a guideline can be identified at the level of the clinician, the patient or the practice setting; however, the shortcomings of the guidelines themselves have received little attention. In this paper, we review the hypertension guidelines that are most commonly encountered by Canadian clinicians: the "1999 Canadian Recommendations for the Management of Hypertension," "The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" in the United States and the "1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension." The key points of these guidelines are compared and the shortcomings that may impede their ability to influence practice are discussed. The main implications for future guideline developers are outlined. [ABSTRACT FROM AUTHOR]

Announces the appointment of Dr. John Dossetor as ombudsman for the 'Canadian Medical Association Journal' and resident consultant in publication ethics. Background on Dossetor who is emeritus professor in Medicine and Bioethics of the University of Alberta at Edmonton; His duties, including the investigation of complaints about the journal's editorial process.

Background: The results of randomized trials show that breast cancer screening by mammography reduces breast cancer mortality by up to 40% in women aged 50-69 years. Because of these results, by 1998, 22 countries, including Canada, had established population-based organized screening programs. This paper presents the results of screening mammography in 1996 for 7 provincially organized breast cancer screening programs in Canada. [ABSTRACT FROM AUTHOR]

AbstractBackground: In 1996 the number of deaths and admissions to hospital in Canada that could be attributed to the use of alcohol, tobacco and illicit drugs were estimated from 1992 data. In this paper we update these estimates to the year 1995.Methods: On the basis of pooled estimates of relative risk, etiologic fractions were calculated by age, sex and province for 90 causes of disease or death attributable to alcohol, tobacco or illicit drugs; the etiologic fractions were then applied to national mortality and morbidity data for 1995 to estimate the number of deaths and admissions to hospital attributable to substance abuse.Results: In 1995, 6507 deaths and 82 014 admissions to hospital were attributed to alcohol, 34 728 deaths and 194 072 admissions to hospital were attributed to tobacco, and 805 deaths and 6940 admissions to hospital were due to illicit drugs.Interpretation: The use and misuse of alcohol, tobacco and illicit drugs accounted for 20.0% of deaths, 22.2% of years of potential life lost and 9.4% of admissions to hospital in Canada in 1995. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown reductions in the volume of emergency department visits early in the COVID-19 pandemic, but few have evaluated the pandemic's impact over time or stratified analyses by reason for visits. We aimed to quantify such changes in British Columbia, Canada, cumulatively and during prominent nadirs, and by reason for visit, age and acuity. Methods: We included data from the National Ambulatory Care Reporting System for 30 emergency departments across BC from January 2016 to December 2022. We fitted generalized additive models, accounting for seasonal and annual trends, to the monthly number of visits to estimate changes throughout the pandemic, compared with the expected number of visits in the absence of the pandemic. We determined absolute and relative differences at various times during the study period, and cumulatively since the start of the pandemic until the overall volume of emergency department visits returned to expected levels. Results: Over the first 16 months of the pandemic, the volume of emergency department visits was reduced by about 322 300 visits, or 15% (95% confidence interval 12%–18%), compared with the expected volume. A sharp drop in pediatric visits accounted for nearly one-third of the reduction. The timing of the return to baseline volume of visits differed by subgroup. The largest and most sustained decreases were in respiratory-related emergency department visits, visits among children, visits among oldest adults and non-urgent visits. Later in the pandemic, we observed increased volumes of highest-urgency visits, visits among children and visits related to ear, nose and throat. Interpretation: We have extended evidence that the impact of the COVID-19 pandemic and associated mitigation strategies on emergency department visits in Canada was substantial. Both our findings and methods are relevant in public health surveillance and capacity planning for emergency departments in pandemic and nonpandemic times. [ABSTRACT FROM AUTHOR]

Background: The increasing toxicity of opioids in the unregulated drug market has led to escalating numbers of overdoses in Canada and worldwide; takehome naloxone (THN) is an evidence-based intervention that distributes kits containing naloxone to people in the community who may witness an overdose. The purpose of this guidance is to provide policy recommendations for territorial, provincial and federal THN programs, using evidence from scientific and grey literature and community evidence that reflects 11 years of THN distribution in Canada. Methods: The Naloxone Guidance Development Group — a multidisciplinary team including people with lived and living experience and expertise of drug use — used the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument to inform development of this guidance. We considered published evidence identified through systematic reviews of all literature types, along with community evidence and expertise, to generate recommendations between December 2021 and September 2022. We solicited feedback on preliminary recommendations through an External Review Committee and a public input process. The project was funded by the Canadian Institutes of Health Research through the Canadian Research Initiative in Substance Misuse. We used the Guideline International Network principles for managing competing interests. Recommendations: Existing evidence from the literature on THN was of low quality. We incorporated evidence from scientific and grey literature, and community expertise to develop our recommendations. These were in 3 areas: routes of naloxone administration, THN kit contents and overdose response. Take-home naloxone programs should offer the choice of both intramuscular and intranasal formulations of naloxone in THN kits. Recommended kit contents include naloxone, a naloxone delivery device, personal protective equipment, instructions and a carrying case. Trained community overdose responders should prioritize rescue breathing in the case of respiratory depression, and conventional cardiopulmonary resuscitation in the case of cardiac arrest, among other interventions. Interpretation: This guidance development project provides direction for THN programs in Canada in the context of limited published evidence, with recommendations developed in collaboration with diverse stakeholders. [ABSTRACT FROM AUTHOR]

Background: During the first year of the COVID-19 pandemic, the proportion of reported cases of COVID-19 among Canadians was under 6%. Although high vaccine coverage was achieved in Canada by fall 2021, the Omicron variant caused unprecedented numbers of infections, overwhelming testing capacity and making it difficult to quantify the trajectory of population immunity. Methods: Using a time-series approach and data from more than 900 000 samples collected by 7 research studies collaborating with the COVID-19 Immunity Task Force (CITF), we estimated trends in SARS-CoV-2 seroprevalence owing to infection and vaccination for the Canadian population over 3 intervals: prevaccination (March to November 2020), vaccine roll-out (December 2020 to November 2021), and the arrival of the Omicron variant (December 2021 to March 2023). We also estimated seroprevalence by geographical region and age. Results: By November 2021, 9.0% (95% credible interval [CrI] 7.3%–11%) of people in Canada had humoral immunity to SARS-CoV-2 from an infection. Seroprevalence increased rapidly after the arrival of the Omicron variant — by Mar. 15, 2023, 76% (95% CrI 74%–79%) of the population had detectable antibodies from infections. The rapid rise in infection-induced antibodies occurred across Canada and was most pronounced in younger age groups and in the Western provinces: Manitoba, Saskatchewan, Alberta and British Columbia. Interpretation: Data up to March 2023 indicate that most people in Canada had acquired antibodies against SARS-CoV-2 through natural infection and vaccination. However, given variations in population seropositivity by age and geography, the potential for waning antibody levels, and new variants that may escape immunity, public health policy and clinical decisions should be tailored to local patterns of population immunity. [ABSTRACT FROM AUTHOR]

I thank the members of the special issue working group - Dr. Mojola Omole, Dr. Notisha Massaquoi, Ms. Camille Orridge, Dr. Bukola Salami, Dr. Andreas Laupacis and Ms. Erin Russell - who have given so many hours of their time to this project. It is with great pleasure and pride that I introduce the next 2 issues of I CMAJ i , which centre the health of Black people in Canada and explore anti-Black racism in Canadian health care spaces. These 2 special issues grew out of a meeting in late 2020 between 2 co-leads of the Black Health Education Collaborative (BHEC), Dr. Onye Nnorom and Dr. OmiSoore Dryden, and Dr. Andreas Laupacis and me, not long after the murder of Mr. George Floyd. [Extracted from the article]

Focuses on the question of whether active euthanasia should sometimes be allowed. The difference between passive and active euthanasia; The acceptance of passive euthanasia by the Canadian Medical Association (CMA); The cases against Dr. Claudio Alberto de la Rocha and Dr. Nancy Morrison, both of Canada, and their participation in acts of euthanasia; Mention of the papers `Active and passive euthanasia,' by James Rachels and `Killing and letting die,' by Philippa Foot.

Presents a paper that reports on the first study in Canada to use physician records to assess the use of prostate-specific antigen (PSA) testing. Methods; Results; Conclusions.

Conclusion Physician health policies across Canada aim to protect the public by regulating practice for physicians who may be impaired. The UK regulatory model offers the benefits of transparency, explicit efforts to reduce stigma around disabilities and health conditions, and simultaneous reflection of physician responsibilities alongside available health supports. Ideally, such policies should encourage physician self-disclosure of illness, which serves to protect patients while avoiding intrusive questions about physicians' health. [Extracted from the article]

The article offers information related to the data stewardship and role of the physicians in Canada. It mentions that data stewardship refers to the collection, management and security of health information by a health professional. It informs that physician can get assistance over the issue of data stewardship from Canadian Medical Association guidelines for protecting the privacy of individual patient records in an electronic environment and ensuring physicians use of e-health tools.

Background: Accessible measures specific to the Canadian context are needed to support health system planning for older adults living with frailty. We sought to develop and validate the Canadian Institute for Health Information (CIHI) Hospital Frailty Risk Measure (HFRM). Methods: Using CIHI administrative data, we conducted a retrospective cohort study involving patients aged 65 years and older who were discharged from Canadian hospitals from Apr. 1, 2018, to Mar. 31, 2019. We used a 2-phase approach to develop and validate the CIHI HFRM. The first phase, construction of the measure, was based on the deficit accumulation approach (identification of age-related conditions using a 2-year look-back). The second phase involved refinement into 3 formats (continuous risk score, 8 risk groups and binary risk measure), with assessment of their predictive validity for several frailty-related adverse outcomes using data to 2019/20. We assessed convergent validity with the United Kingdom Hospital Frailty Risk Score. Results: The cohort consisted of 788 701 patients. The CIHI HFRM included 36 deficit categories and 595 diagnosis codes that cover morbidity, function, sensory loss, cognition and mood. The median continuous risk score was 0.111 (interquartile range 0.056–0.194, equivalent to 2–7 deficits); 35.1% (n = 277 000) of the cohort were found at risk of frailty (≥ 6 deficits). The CIHI HFRM showed satisfactory predictive validity and reasonable goodness-of-fit. For the continuous risk score format (unit = 0.1), the hazard ratio (HR) for 1-year risk of death was 1.39 (95% confidence interval [CI] 1.38–1.41), with a C-statistic of 0.717 (95% CI 0.715–0.720); the odds ratio for high users of hospital beds was 1.85 (95% CI 1.82–1.88), with a C-statistic of 0.709 (95% CI 0.704–0.714), and the HR of 90-day admission to long-term care was 1.91 (95% CI 1.88–1.93), with a C-statistic of 0.810 (95% CI 0.808–0.813). Compared with the continuous risk score, using a format of 8 risk groups had similar discriminatory ability and the binary risk measure had slightly weaker performance. Interpretation: The CIHI HFRM is a valid tool showing good discriminatory power for several adverse outcomes. The tool can be used by decision-makers and researchers by providing information on hospital-level prevalence of frailty to support system-level capacity planning for Canada's aging population. [ABSTRACT FROM AUTHOR]

The article focuses on Canadian initiatives on driving competency among older patients. It states that the family driving agreements of Keeping Us Safe allow older drivers to designate a companion to inform them when to stop driving. It says that a paper by Paige Moorhouse and colleagues has found that 30% of Canadians with dementia still drive despite their condition. It also discusses the Independent Transportation Network America program that allows people to trade vehicles to pay for rides.

The article reports on the potential benefits of medical research projects on actual patients that may improve clinical settings. According to doctor Alain Beaudet, Canadian Institutes of Health Research (CIHR) president, Canada needs to focus more on patient-oriented researches to improve medial research. It states that CIHR discussion paper "Strategy for Patient-Oriented Research" includes activities that need to be address after the research such as translation and dissemination.

The article reports that Health Canada is proposing a new regulatory regime for pharmaceuticals and biologics. The proposition was to support its move to lower the threshold for initial market authorization licenses in exchange for additional safety and efficacy studies as the condition for selling drug. The regulatory regime incorporates the notion of post-market surveillance into Health Canada. Nevertheless, the changes that the proposed regime offers are still being reviewed.

Interviews Neill Iscoe, a medical oncologist at the Toronto-Sunnybrook Regional Cancer Centre and an assistant professor at the University of Toronto. His most influential teacher; The aspect of his work that gives him the most pleasure; The two research papers that have had the greatest influence on his career; Other details.

The article stresses the importance of social determinants, such as income, on health outcomes and the role of physicians in addressing them. Topics discussed include the policy papers of the Canadian Medical Association (CMA) on the role of physicians in addressing the social determinants and health equity and a series of public town meetings across Canada on what makes people sick hosted by the CMA.

This section offers news briefs relating to the health industry in Canada as of March 20, 2015. A research paper published in the "Canadian Medical Association Journal (CMAJ)" reveals that a national pharmacare plan can reduce spending on prescription drugs in Canada. A report from Fraser Institute reveals that more than 52,000 Canadians received non-emergency medical care outside Canada in 2014. Decentralized health care system will again be used in Alberta, Canada.

Background: Inappropriate health care leads to negative patient experiences, poor health outcomes and inefficient use of resources. We aimed to conduct a systematic review of inappropriately used clinical practices in Canada. Methods: We searched multiple bibliometric databases and grey literature to identify inappropriately used clinical practices in Canada between 2007 and 2021. Two team members independently screened citations, extracted data and assessed methodological quality. Findings were synthesized in 2 categories: diagnostics and therapeutics. We reported ranges of proportions of inappropriate use for all practices. Medians and interquartile ranges (IQRs), based on the percentage of patients not receiving recommended practices (underuse) or receiving practices not recommended (overuse), were calculated. All statistics are at the study summary level. Results: We included 174 studies, representing 228 clinical practices and 28 900 762 patients. The median proportion of inappropriate care, as assessed in the studies, was 30.0% (IQR 12.0%-56.6%). Underuse (median 43.9%, IQR 23.8%-66.3%) was more frequent than overuse (median 13.6%, IQR 3.2%-30.7%). The most frequently investigated diagnostics were glycated hemoglobin (underused, range 18.0%-85.7%, n = 9) and thyroid-stimulating hormone (overused, range 3.0%-35.1%, n = 5). The most frequently investigated therapeutics were statin medications (underused, range 18.5%-71.0%, n = 6) and potentially inappropriate medications (overused, range 13.5%-97.3%, n = 9). Interpretation: We have provided a summary of inappropriately used clinical practices in Canadian health care systems. Our findings can be used to support health care professionals and quality agencies to improve patient care and safety in Canada. [ABSTRACT FROM AUTHOR]

The article present an answer to a question related to the best possible use of your electronic medical record (EMR).

The article focuses on a study related to the high cost of hospital readmissions in Canada. It reports that about 8.5 percent of patients in acute care settings are readmitted to hospital within 30 days. The study reports that the community factors associated with readmission rates include access to post-acute care services and neighborhood affluence. It also states that the readmission rates were high in rural areas in comparison to urban areas.

The article presents information about the Gerry Lynch Memorial Scholarship. The scholarship was established in 1995 in honor of Gerry Lynch, former executive director of the Newfoundland and Labrador Medical Association (NLMA). The annual scholarship is provided to a graduating medical student who is to attend the Memorial University in Saint John's, Newfoundland for completion of a research paper. The 2006 scholarship of $3,000 went to Crystal Hann, a medical student.

The article focuses on possible harm to public health posed by bisphenol A in Canada. It mentions that perinatal exposure to the bisphenol A can alter the development of several organs and organ systems. It informs that bisphenol A is found in consumer products including baby bottles, reusable water bottles, and sports equipment. It reveals that in a Canadian study of 5476 people, 90.7 percent had detectable levels of bisphenol A.