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Introduction: Severe gastrointestinal dysmotility disorder (GID) constitute approximately 20% of patients requiring home parenteral nutrition (HPN), whereas short-bowel syndrome (SBS) remains the most frequent indication for HPN. This study's aim was to characterize GID patients and compare clinical parameters and survival to SBS patients. Similarly, clinical comparisons between sclerodermaand nonscleroderma patients were made.Methods: Demographic and clinical data for all patients was extracted from the Canadian HPN Registry from January 1, 2003, to November 1, 2018. Kaplan-Meier method was used to estimate the unadjusted survival probability, and log-rank test was used to compare the survival probability between groups.Result: 270 patients (52 GID and 218 SBS) were included in the analysis. For all patients, higher mortality was associated with age (hazard ratio [HR], 1.02 [1.00-1.04]; P = .05), PN dependence (HR, 1.01 [1.00-1.02]; P = .04), hospitalizations (HR, 1.21 [1.10-1.33]; P < .001), and use of immunosuppressant (HR, 1.97 [1.02-3.82]; P = .04). The 5- and 10-year actuarial survival probabilities between GID and SBS were not significantly different (5-year: 70.0% vs 59.2%; 10-year: 79.6% vs 66.2% [P = .5], respectively). There was no difference in survival between scleroderma and nonscleroderma patients (P = .67).Conclusion: T5- and 10- year survival probabilities were similar between GID and SBS patients. The diagnosis of scleroderma had no effect on survival. Use of immunosuppressant, older age, PN dependence, and number of hospitalizations per PN duration are risk factors for mortality in both the GID and SBS groups. [ABSTRACT FROM AUTHOR]

The article presents a panel discussion on cultural communities and immigration, with reference to Quebec and an end of century examination of changes in the period between 1980 and 2011. Panel participants include former Quebec minister of immigration, Robert Trempe, Fo Niemi, director of the Centrre de recherche-action sur les relations raciales, and University of Montreal ethnic relations and ethnic relations education chair, Marie Mc Andrew, with education professor Jean-Pierre Proulx leading the discussion.

The use of medical cannabis to treat drug-resistant epilepsy in children is increasing; however, there has been limited study of the experiences of parents with the current system of accessing medical cannabis for their children. In this qualitative study, we used a patient-centered access to care framework to explore the barriers faced by parents of children with drug-resistant epilepsy when trying to access medical cannabis in Canada. We conducted semistructured interviews with 19 parents to elicit their experiences with medical cannabis. We analyzed the data according to five dimensions of access, namely approachability, acceptability, availability, affordability, and appropriateness. Parents sought medical cannabis as a treatment because of a perceived unmet need stemming from the failure of antiepileptic drugs to control their children's seizures. Medical cannabis was viewed as an acceptable treatment, especially compared with adding additional antiepileptic drugs. After learning about medical cannabis from the media, friends and family, or other parents, participants sought authorization for medical use. However, most encountered resistance from their child's neurologist to discuss and/or authorize medical cannabis, and many parents experienced difficulty in obtaining authorization from a member of the child's existing care team, leading them to seek authorization from a cannabis clinic. Participants described spending up to $2000 per month on medical cannabis, and most were frustrated that it was not eligible for reimbursement through public or private insurance programs. Parents pursue medical cannabis as a treatment for their children's drug-resistant epilepsy because of a perceived unmet need. However, parents encounter barriers in accessing medical cannabis in Canada, and strategies are needed to ensure that children using medical cannabis receive proper care from healthcare professionals with training in epilepsy care, antiepileptic drugs, and medical cannabis. • We explored barriers to accessing medical cannabis for children with drug-resistant epilepsy. • Medical cannabis may fill an unmet need for children with drug-resistant epilepsy. • Most parents encountered resistance from their child's neurologist about medical cannabis. • Parents were frustrated that medical cannabis is not eligible for insurance coverage. [ABSTRACT FROM AUTHOR]

Objective: To identify the scope and volume of cross-border fertility services in Canada and the U.S. and to evaluate the three-way communication between patients and their service providers in 2008. Design: Mail and on-line surveys of cross-border fertility care activity were sent to 34 Canadian and 392 American fertility clinics and clinicians. Main Outcome Measure(s): Clinician and patient experience with assisted reproductive technologies. Result(s): The most commonly reported cross-border treatment sought by Canadians was anonymous donor–oocyte in vitro fertilization (IVF; 363 out of 452, 80%). For patients entering Canada to receive fertility treatment, the largest demand was for IVF (106 out of 146, 73%). The majority of out-of-country patients received by U.S. clinics sought standard IVF (927 out of 1,809, 51%), most of these coming from Europe (25%) and Latin America (39%). The largest proportion of patients leaving the U.S. to receive IVF (41%) or donor-egg IVF (52%) traveled to India/Asia. Concurrence was seen between Canadian and U.S. clinics'' ratings of key data that should be provided along with returning patients. Experience of earlier patients with individual centers and perceived safety and effectiveness of care are the key factors in choice of destination. Conclusion(s): Anonymous donor–oocyte IVF is the main assisted reproductive technology sought by Canadians traveling to the U.S. India and Asia are the main destinations for U.S. women leaving the country for their fertility care. Three-way communication between patients and sending and receiving clinics is an important element of safe and effective care. [Copyright &y& Elsevier]

Objective: To develop and test a nonidentifying prospective data collection system for cross-border reproductive care (CBRC) in Canada and the United States (U.S.).Design: Survey and cross-sectional study.Setting: Fertility clinics.Patient(s): Women traveling to and from Canada and the U.S. for reproductive care.Intervention(s): None.Main Outcome Measure(s): Patients' home country, reason for crossing borders, and type of care received.Result(s): Of 32 Canadian and 440 U.S. clinics contacted, seven and 46, respectively, responded to the initial questionnaire. Three out of seven Canadian and 44 out of 46 U.S. clinics reported providing CBRC. Seventy five percent agreed that nonidentifying data on country of origin and reason for travel should be collected. However, only one of seven Canadian and none of 46 U.S. clinics that expressed initial interest actually collected data, despite multiple communications.Conclusion(s): Although CBRC is a major component of assisted reproductive technology in North America (3%-10% of IVF cycles are provided to out-of-country patients in Canada and the U.S.), clinicians are not motivated to collect the simplest of data regarding CBRC patients. Despite this, reliable data are needed to help better understand the reasons for and impact of CBRC. [ABSTRACT FROM AUTHOR]