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The article presents the perspectives of a student who has an experience in publication and that of a senior clinician and researcher who has guided several medical students and residents through the process of doing health care research. The information as obtained from the two respondents primarily aims to encourage medical students to do research and write papers about medicine. Details and a summary of both student and the faculty member are posted.

Background: The public gets most of its information about genetic research from the media. It has been suggested that media representations may involve exaggeration, called "genohype." To examine the accuracy and nature of media coverage of genetic research, we reviewed the reporting of single-gene discoveries and associated technologies in major daily newspapers in Canada, the United States, Great Britain and Australia.Methods: We used neutral search terms to identify articles about gene discoveries and associated technologies hosted on the Dow Jones Interactive and Canadian NewsDisk databases from January 1995 to June 2001. We compared the contents, claims and conclusions of the scientific journal article with those of the associated newspaper article. Coders subjectively assigned the newspaper articles to 1 of 3 categories: moderately to highly exaggerated claims, slightly exaggerated claims or no exaggerated claims. We used classification tree software to identify the variables that contributed to the assignment of each newspaper article to 1 of the 3 categories: attention structure (positioning in the newspaper and length of the article), authorship, research topic, source of information other than the scientific paper, type and likelihood of risks and benefits, discussion of controversy, valuation tone (positive or negative), framing (e.g., description of research, celebration of progress, report of economic prospects or ethical perspective), technical accuracy (either omissions or errors that changed the description of the methods or interpretation of the results) and use of metaphors.Results: We examined 627 newspaper articles reporting on 111 papers published in 24 scientific and medical journals. Only 11% of the newspaper articles were categorized as having moderately to highly exaggerated claims; the majority were categorized as having no claims (63%) or slightly exaggerated claims (26%). The classification analysis ranked the reporting of risks as the most important variable in determining the categorization of newspaper articles. Only 15% of the newspaper articles and 5% of the scientific journal articles discussed costs or risks, whereas 97% of the newspaper articles and 98% of the scientific journal articles discussed the likelihood of benefits of the research.Interpretation: Our data suggest that the majority of newspaper articles accurately convey the results of and reflect the claims made in scientific journal articles. Our study also highlights an overemphasis on benefits and under-representation of risks in both scientific and newspaper articles. The cause and nature of this trend is uncertain. [ABSTRACT FROM AUTHOR]

SEVERAL SCIENTIFIC AND GENERAL MEDICAL JOURNALS publish full-length articles on their Web sites and abridged versions in their print journals. We surveyed a stratified random sample of BMJ readers and authors to elicit their preferred format for the abridged print version. Each participant received a research paper abridged in 3 different formats: conventional abridged version, journalistic version and enhanced-abstract version. Overall, 45% (95% confidence interval [CI] 42%--48%) of the respondents said they liked the conventional version most, 31% (95% CI 28%--34%) preferred the journalistic version and 25% (95% CI 22%--27%) preferred the enhanced-abstract version. Twenty-eight percent (95% CI 25%--32%) indicated that use of the journalistic format for abridged articles would very likely stop them from submitting papers to BMJ, and 13% (95% CI 11%--16%) said the use of the enhanced-abstract version would stop them from submitting to BMJ. Publishers of general medical journals who publish shortened articles should consider that authors and readers prefer a more conventional style of abridged papers. [ABSTRACT FROM AUTHOR]

Offers commentary regarding the decision of the International Committee of Medical Journal Editors, which revised its statement on authorship. Effect this change would have had on the authorship of a paper printed in the March 1922 issue of the 'Canadian Medical Association Journal'; Details of the paper which reported that pancreatic extract reduced blood sugar levels in a diabetic patient; Description of the contributing authors to the paper.

In this article, the author reflects on the facts in relation to medical science. He gives reference to the supplementary appendix to the Pronovost paper 1 that included the line about handwashing, which confirmed that infections had been reported even when gloves were worn. He further refers to another paper published in 1993 in several science journals that showed that nearly 13 per cent of gloved hands later showed contamination after routine use.

Harry Benjamin (1885–1986) was a German-American physician who played a significant role in the early history of transgender medicine. He wrote the groundbreaking book "The Transsexual Phenomenon" in 1966 and advocated for compassionate treatment of transgender individuals. Benjamin initially focused on geriatrics in his medical practice but became interested in the therapeutic possibilities of endocrine glands. He had connections with Magnus Hirschfeld, a German physician and activist for homosexual rights, and was willing to use medical tools to help transgender individuals align their bodies with their gender identity. Benjamin's approach was cautious, urging patients to proceed slowly and only change their bodies as a last resort. He provided hormone therapy and practical aid, such as testifying on his patients' behalf in court and helping them obtain identification papers. Benjamin's work influenced a generation of transgender people and health professionals, and he became the physician to over a thousand transgender individuals. While his approach may seem old-fashioned by today's standards, Benjamin's compassionate and respectful treatment of his patients eased their suffering and opened up a new field of care. [Extracted from the article]

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.

The article reports that American Health care system wastes about 750 million U.S. dollars in unnecessary medical procedure and paper works. It highlights the utmost need to improve quality of medical care provided by medical institutions in the U.S. to the patients for their satisfaction in medical facilities. It mentions that the patients' grievances can be solved through greater use of electronic health records and provision of delivering evidence based care to patients.

An editorial is presented related to the open policy of the periodical permitting preprints. Topics discussed include preprints, that are the scholarly papers posted by authors in an openly accessible platform, usually before submission to a journal for formal publication; the importance of preprints as they may help reduce research waste and publication bias; and the inherent risks associated with posting preprints.

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.

The article reports that U.S. politicians Darrell Issa and Carolyn Maloney cosponsored Research Works Act aims to put an end to freely available medical researches. If passed, it would reinstate a pay system for medical researches and will prohibit agencies like the U.S. National Institutes of Health (NIH) to make them free. Alliance for Taxpayer Access is asking physicians and researchers to oppose it. According to critics, Issa and Maloney have received contributions from publishers.

We appreciate and have carefully considered Dr. Jain's response.[1] We opted to reduce (not eliminate) bias caused by the unequal distribution of medical risk factors by type of most responsible provider (MRP) using a validated weighted risk score to group birthers into prenatal risk groups. We appreciate the etiological consideration Dr. Jain suggested and can also think of factors that might predispose midwifery clients to worse outcomes. With respect to MRP assignment, MRP is a mandatory data field, is clearly defined in our paper and, in our view, is the best variable to use when describing outcomes of midwife-led care. [Extracted from the article]

resents an article about the use of electronic medical records in the U.S. Percentage of physicians that did not have sufficient electronic access to their patients' records; Motivation of physicians for using electronic medical records; Requirements for an electronic health records system.

An essay is presented on zen and the art of painting. It offers information regarding the life and works of the author who is a hematologist and a teacher. The author, who is also a wife and the mother of three children, suffered from Parkinson disease in mid-life. According to the author, there are only two times when she forgets about the Parkinson disease: when she is solving a difficult clinical case, and when she is painting.

The article discusses the results of the 2014 National Physical Survey (NPS). Results mentioned include 21.3 percent of physicians reporting using only paper charts to enter and retrieve clinical patient notes, 29.4 percent of physicians reporting that they exclusively use electronic records, and how the switch from paper to electronic medical records (EMR) has become a standard of practice in the modern primary health care clinic.

I would appreciate someone checking my "back of the envelope" numbers, but if they are correct, this paper shows that providers should be considering melanoma risk in our review of drug options for patients with hypertension. Drucker and colleagues provide a great paper[1] that raises questions about antihypertensive medications and adverse effects. [Extracted from the article]

The author reflects on the reasons behind the accumulation of a large volume of paper even when physicians are using an electronic medical record (EMR). He explains that physicians with EMRs do not have the ability to talk to all the community pharmacies electronically and that laboratory investigation forms and consult requests for specialists must still be done on hand. He asserts that data standards, secure pipes and digital identities are some of the reasons why EMRs are not widely implemented.

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

This article discusses the importance of an electronic medical record (EMR) in the health care industry. An EMR contributes to improved patient care and office efficiency. Some of the obstacles that hinders the adoption of the EMR include reluctant physicians that needs to understand that they can provide personal attention to a patient even when computers invade the examination room and the apprehension relating to the transition to electronic records.

Background: Gaps continue to exist between research-based evidence and clinical practice. We surveyed health care providers in 10 low- and middle-income countries about their use of research-based evidence and examined factors that may facilitate or impede such use. Methods: We surveyed 1499 health care providers practising in one of four areas relevant to the Millennium Development Goals (prevention of malaria, care of women seeking contraception, care of children with diarrhea and care of patients with tuberculosis) in each of China, Ghana, India, Iran, Kazakhstan, Laos, Mexico, Pakistan, Senegal and Tanzania. Results: The proportion of respondents who re ported that research was likely to change their clinical practice if performed and published in their own country (84.6% and 86.0% respectively) was higher than the proportion who reported the same about research and publications from their region (66.4% and 63.1%) or from high-income countries (55.8% and 55.5%). Respondents who were most likely to report that the use of research-based evidence led to changes in their practice included those who reported using clinical practice guidelines in paper format (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.03-2.28), using scientific journals from their own country in paper format (OR 1.70, 95% CI 1.26-2.28), viewing the quality of research performed in their country as above average or excellent (OR 1.93, 95% CI 1.16-3.22); trusting systematic reviews of randomized controlled trials (OR 1.59, 95% CI 1.08-2.35); and having easy access to the Internet (OR 1.90, 95% CI 1.19-3.02). Interpretation: Locally conducted or published research has played an important role in changing the professional practice of health care providers surveyed in low- and middle-income countries. Increased investments in local research, or at least in locally adapted publications of research-based evidence from other settings, are therefore needed. Although access to the Internet was viewed as a significant factor in whether research-based evidence led to concrete changes in practice, few respondents reported having easy access to the Internet. Therefore, efforts to improve Internet access in clinical settings need to be accelerated. [ABSTRACT FROM AUTHOR]

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]

The Canadian Medical Association Journal (CMAJ) has announced the closure of CMAJ Open due to budget cuts. Although the journal is no longer accepting new submissions, the editors have continued to process existing manuscripts. The last four articles were published on December 19, 2023. CMAJ Open, an Open Access research journal, has provided a platform for health researchers in Canada to disseminate their work for the past 11 years. The journal's archives will remain accessible online, and its articles will continue to be freely available. CMAJ Open has published a wide range of research across various medical disciplines, including clinical, environmental science, public health, and sociology. The journal employed an open peer review model, which aimed to increase transparency in the peer review process. Over the years, CMAJ Open has received 2143 manuscripts, with 1041 being published. The journal has also created dedicated collections for patient-oriented research and COVID-19-related research. The editor-in-chief expresses gratitude to all those who have contributed to the journal and believes that the work published in CMAJ Open will remain valuable to readers in the future. [Extracted from the article]

The article focuses on the problems with the system of retractions of scientific studies in medical journals. It states that medical journals handle retractions of study poorly as they did not provide clear explanations of the reason behind the retractions and the publication of the retracted studies. It says that all the retracted papers are grouped into one category, although they have varied reasons for their retraction that range from unintended mistakes to outright fraud.

Background: Worldwide, countries are examining whether to implement 1-dose human papillomavirus (HPV) vaccination instead of using 2 doses. To inform policy, we sought to project the population-level impact and efficiency of switching from 2-dose to 1-dose gender-neutral routine HPV vaccination in Canada. Methods: We used HPV-ADVISE, an individual-based transmission-dynamic model of HPV infections and diseases, to mathematically model vaccination programs in 2 provinces, Quebec, a province with high HPV vaccination coverage (around 85%), and Ontario, which has lower coverage (around 65%). We examined non-inferior and pessimistic scenarios of the efficacy (vaccine efficacy of 98% or 90%) and average vaccine duration (lifelong, 30 yr, or 25 yr) of 1 dose compared with 2 doses (98% vaccine efficacy, lifelong vaccine duration). Our main outcomes were the relative reduction in HPV-16 (by sex) and cervical cancers, and the number of doses needed to prevent 1 cervical cancer. Results: Our model projected that 1-dose HPV vaccination would avert a similar number of cervical cancers as 2 doses in Canada, under various scenarios. Under the most pessimistic scenario (25-yr vaccine duration), 1-dose vaccination would avert fewer cervical cancers than 2 doses, by about 3 percentage points over 100 years. All 1-dose scenarios were projected to lead to elimination of cervical cancer (< 4 cervical cancers/100 000 female-years) and to be a substantially more efficient use of vaccine doses than a 2-dose scenario (1-dose v. no vaccination = 800–1000 doses needed to prevent 1 cervical cancer; incremental doses for 2-dose v. 1-dose vaccination > 10 000 doses needed to prevent 1 additional cervical cancer). Interpretation: If the average duration of 1-dose protection is longer than 25 years, a 1-dose HPV vaccination program would protect those vaccinated during their peak ages of sexual activity and prevent a similar number of HPV-related cancers as a 2-dose program, while being a more efficient use of vaccine doses. [ABSTRACT FROM AUTHOR]

Background: Public funding of cataract surgery provided in private, for-profit surgical centres increased to help mitigate surgical backlogs during the COVID-19 pandemic in Ontario, Canada. We sought to compare the socioeconomic status of patients who underwent cataract surgery in not-for-profit public hospitals with those who underwent this surgery in private for-profit surgical centres and to evaluate whether differences in access by socioeconomic status decreased after the infusion of public funding for private, for-profit centres. Methods: We conducted a population-based study of all cataract operations in Ontario, Canada, between January 2017 and March 2022. We analyzed differences in socioeconomic status among patients who accessed surgery at not-for-profit public hospitals versus those who accessed it at private for-profit surgical centres before and during the period of expanded public funding for private for-profit centres. Results: Overall, 935 729 cataract surgeries occurred during the study period. Within private for-profit surgical centres, the rate of cataract surgeries rose 22.0% during the funding change period for patients in the highest socioeconomic status quintile, whereas, for patients in the lowest socioeconomic status quintile, the rate fell 8.5%. In contrast, within public hospitals, the rate of surgery decreased similarly among patients of all quintiles of socioeconomic status. During the funding change period, 92 809 fewer cataract operations were performed than expected. This trend was associated with socioeconomic status, particularly within private for-profit surgical centres, where patients with the highest socioeconomic status were the only group to have an increase in cataract operations. Interpretation: After increased public funding for private, for-profit surgical centres, patient socioeconomic status was associated with access to cataract surgery in these centres, but not in public hospitals. Addressing the factors underlying this incongruity is vital to ensure access to surgery and maintain public confidence in the cataract surgery system. [ABSTRACT FROM AUTHOR]

That date marks the expiry of Bill C-7's exception for MAiD in circumstances where a mental disorder is the sole underlying medical condition. Another recent paper by the same group complements this work by leveraging the European experience in another way - the iterative development of an expert consensus-based set of criteria for MAiD in circumstances where a mental disorder is the sole underlying medical condition.[2] The current MAiD reporting requirements[3] are insufficient to address the crucial upcoming questions regarding MAiD in the context described above. The recent article by van Veen and colleagues[1] provides a window into a possible future for Canadian practice regarding medical assistance in dying (MAiD) among people for whom a mental disorder is the sole underlying medical condition. [Extracted from the article]

Similarly, despite World Health Organization guidelines suggesting only 10%-15% of women require cesarean section, the researchers found that 29% of physicians giving birth had the procedure, a rate only slightly below that of other patients (31%). Graph: The cesarean rate among physician and nonphysician patients was similar in a recent analysis of US military data. One lesson physicians can learn from this paper, said Jena, is that providing information to a patient about their health and treatments is just one step in providing them with appropriate care. [Extracted from the article]

The article discusses responsibility of medical editors, under circumstances when articles published by them cause harm. It mentions views of Thomas Ploug, from Centre for Applied Ethics and Philosophy of Science at Aalborg University in Copenhagen, Denmark, on editors of medical periodical. It states that medical journal editors contend that their primary responsibility is ensuring the integrity of research.

The article offers information about the interwoven history of mercury poisoning among indigenous people in Ontario, Canada and the 20th century industrial incident in Minamata, Japan. It discusses issues concerning Dryden Chemical Co.'s pulp and paper mill, which generated mercury waste from bleaching paper, and methylmercury, a lipid-soluble compound.

Some nights turned into most nights, and, soon enough, she was spending them lying in bed, gazing upon our constellations on the ceiling, her bright but tired eyes peeking from beneath the blanket. The glow of a flashlight shone through the cracks, and I spotted a book on her knees, a tiny finger trailing along the pages. Placing the paper in front of the flashlight, I pointed it toward the ceiling. [Extracted from the article]

The review paper is a staple of medical literature and, when well executed by an expert in the field, can provide a summary of literature that generates useful recommendations and new conceptualizations of a topic. However, if research results are selectively chosen, a review has the potential to create a convincing argument for a faulty hypothesis. Improper correlation or extrapolation of data can result in dangerously flawed conclusions. The following paper seeks to illustrate this point, using existing research to argue the hypothesis that cigarette smoking enhances endurance performance and should be incorporated into high-level training programs. [ABSTRACT FROM AUTHOR]

Introduction: The factors affecting decision-making at consensus conferences are not well understood. This paper studies the complex association between time to consensus (TTC) and the timing and quality of food, as well as the self-reported level of frustration (PITA factor) with the question at hand. Methods: We came, we saw, we ate. Results: There was an association between the TTC and the time to eating, especially lunch. There was a trend to faster TTC the better the researchers rated the food. The speed of decision-making was also increased when the PITA score was high, especially late in the day. Interpretation: Organizers of large consensus conferences need to be aware of these factors in decision-making and should try to use them to get more controversial items voted to their satisfaction. [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: Unused opioid prescriptions can be a driver of opioid misuse. Our objective was to determine the optimal quantity of opioids to prescribe to patients with acute pain at emergency department discharge, in order to meet their analgesic needs while limiting the amount of unused opioids. Methods: In a prospective, multicentre cohort study, we included consecutive patients aged 18 years and older with an acute pain condition present for less than 2 weeks who were discharged from emergency department with an opioid prescription. Participants completed a pain medication diary for real-time recording of quantity, doses, and names of all analgesics consumed during a 14-day follow-up period. Results: We included 2240 participants, who had a mean age of 51 years; 48% were female. Over 14 days, participants consumed a median of 5 (quartiles, 1–14) morphine 5 mg tablet equivalents, with significant variation across pain conditions (p < 0.001). Most opioid tablets prescribed (63%) were unused. To meet the opioid need of 80% of patients for 2 weeks, we found that those experiencing renal colic or abdominal pain required fewer opioid tablets (8 morphine 5 mg tablet equivalents) than patients who had fractures (24 tablets), back pain (21 tablets), neck pain (17 tablets), or other musculoskeletal pain (16 tablets). Interpretation: Two-thirds of opioid tablets prescribed at emergency department discharge for acute pain were unused, whereas opioid requirements varied significantly based on the cause of acute pain. Smaller, cause-specific opioid prescriptions could provide adequate pain management while reducing the risk of opioid misuse. Trial registration: ClinicalTrials.gov, no. NCT03953534. [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: To eliminate cervical cancer in Canada by 2040, defined as an annual age-standardized incidence rate (ASIR) lower than 4.0 per 100 000 women, the Canadian Partnership Against Cancer (CPAC) identified 3 priorities for action: increasing human papillomavirus (HPV) vaccine coverage, implementing HPV-based screening and increasing screening participation, and improving follow-up after abnormal screen results. Our objective was to explore the impact of these priorities on the projected time to elimination of cervical cancer in British Columbia. Methods: We used OncoSim-Cervical, a microsimulation model led and supported by CPAC and developed by Statistics Canada that simulates HPV transmission and the natural history of cervical cancer for the Canadian population. We updated model parameters to reflect BC's historical participation rates and program design. We simulated the transition to HPV-based screening and developed scenarios to explore the additional impact of achieving 90% vaccination coverage, 95% screening recruitment, 90% ontime screening, and 95% follow-up compliance. We projected cervical cancer incidence, ASIR, and year of elimination for the population of BC for 2023–2050. Results: HPV-based screening at current vaccination, participation, and follow-up rates can eliminate cervical cancer by 2034. Increasing on-time screening and follow-up compliance could achieve this target by 2031. Increasing vaccination coverage has a small impact over this time horizon. Interpretation: With the implementation of HPV-based screening, cervical cancer can be eliminated in BC before 2040. Efforts to increase screening participation and follow-up through this transition could potentially accelerate this timeline, but the transition from cytology- to HPV-based screening is fundamental to achieving this goal. [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: Emergency departments are a last resort for some socially vulnerable patients without an acute medical illness (colloquially known as "socially admitted" patients), resulting in their occupation of hospital beds typically designated for patients requiring acute medical care. In this study, we aimed to explore the perceptions of health care providers regarding patients admitted as "social admissions." Methods: This qualitative study was informed by grounded theory and involved semistructured interviews at a Nova Scotia tertiary care centre. From October 2022 to July 2023, we interviewed eligible participants, including any health care clinician or administrator who worked directly with "socially admitted" patients. Virtual or in-person individual interviews were audio-recorded and transcribed, then independently and iteratively coded. We mapped themes on the 5 domains of the Quintuple Aim conceptual framework. Results: We interviewed 20 nurses, physicians, administrators, and social workers. Most identified as female (n = 11) and White (n = 13), and were in their mid to late career (n = 13). We categorized 9 themes into 5 domains: patient experience (patient description, provision of care); care team well-being (moral distress, hierarchy of care); health equity (stigma and missed opportunities, prejudices); cost of care (wait-lists and scarcity of alternatives); and population health (factors leading to vulnerability, system changes). Participants described experiences caring for "socially admitted" patients, perceptions and assumptions underlying "social" presentations, system barriers to care delivery, and suggestions of potential solutions. Interpretation: Health care providers viewed "socially admitted" patients as needing enhanced care but identified individual, institutional, and system challenges that impeded its realization. Examining perceptions of the people who care for "socially admitted" patients offers insights to guide clinicians and policy-makers in caring for socially vulnerable patients. [ABSTRACT FROM AUTHOR]

Background: The volume of published literature on the evaluation and use of tests for monitoring purposes is sparse. Our aim was to determine the extent to which recommendations for monitoring prostate-specific antigen to detect recurrent prostate cancer consider key factors that should inform rule-based strategies for monitoring. Methods: We reviewed the recommendations made in clinical guidelines for the repeated measurement of prostate-specific antigen in men who have received primary treatment for localized prostate cancer. We assessed the guidelines using the Appraisal of Guidelines for Research and Evaluation Framework. Results: We identified guidelines and statements of best practice from nine organizations. We saw considerable inconsistency in recommendations for testing for prostate -specific antigen as a form of monitoring. Recommendations on when to test appeared to be almost exclusively determined using standard follow-up schedules rather than any scientific basis. Recommendations on when to take action were primarily based on consensus statements or retrospective case series. Eight of the nine guidelines acknowledged the potential presence of measurement variability, but they did not attempt to account for the effect of such variability on the interpretation of the results of tests for prostate-specific antigen. Many recommendations were made with few or no supporting references; however, a variety of papers were cited across guidelines. Of 48 papers cited, 29.1% (14/48) were reviews; the remaining 70.8% (34/48) of papers cited were primary studies. Interpretation: A systematic approach to the development of monitoring schedules using prostate-specific antigen in guidelines for prostate cancer is lacking, due to inadequacies in the available evidence and its use. [ABSTRACT FROM AUTHOR]

Deals with the use of computers in medicine. Advantage of an electronic medical record; Disadvantages of computers.