Complete Lifestyle Medicine Intervention Program-Ontario: Implementation Protocol for a Rural Study.

Background: Sedentary lifestyles, poor nutritional choices, inadequate sleep, risky substance use, limited social connections, and high stress contribute to the growing prevalence of chronic diseases. Lifestyle medicine, emphasizing therapeutic lifestyle changes for prevention and treatment, has demonstrated effectiveness but remains underutilized in clinical settings. The Complete Lifestyle Medicine Intervention Program-Ontario (CLIP-ON) was developed to educate the rural population of Northern Ontario in lifestyle medicine to improve health outcomes and engagement.

The association between neighbourhood marginalization and SARS-CoV-2 outcomes in patients presenting to emergency departments.

Objective: Social and economic marginalizations have been associated with inferior health outcomes in Canada. Our objective was to describe the relationship between neighbourhood marginalization and COVID-19 outcomes among patients presenting to Canadian emergency departments (ED).

Methods: We conducted an observational study among consecutive COVID-19 patients recruited from 47 hospitals participating in the Canadian COVID-19 ED Rapid Response Network (CCEDRRN) between March 3, 2020, and July 24, 2022.

Steatotic liver disease in metastatic breast cancer treated with endocrine therapy and CDK4/6 inhibitor.

Purpose: In early-stage breast cancer, steatotic liver disease (SLD) is associated with increased recurrence, cardiovascular events, and non-cancer death. Endocrine therapy (ET) increases the risk of SLD. The impact of cyclin-dependent kinases 4/6 inhibitors (CDK4/6i) on SLD and prognostic association in metastatic breast cancer is unknown.

Risk of bleeding with the concurrent use of amiodarone and DOACs: A systematic review and meta-analysis.

Background And Aims: Amiodarone is frequently prescribed alongside direct oral anticoagulants (DOACs) in atrial fibrillation (AF). There are concerns regarding drug-drug interactions (DDIs) between amiodarone and DOACs. The literature is conflicting on the clinical implications of this DDI, hence we conducted a meta-analysis to compare bleeding risk among patients receiving DOACs, with and without concurrent amiodarone.

Trends, characteristics, and circumstances surrounding stimulant toxicity deaths in Ontario, Canada from 2018 to 2021.

Introduction: As the drug toxicity crisis continues to evolve globally, harms related to non-opioid substances, including stimulants, have risen in parallel. Our study aims were to describe trends in accidental stimulant toxicity deaths and to characterize demographic characteristics of decedents and the circumstances surrounding death.

Methods: We conducted a population-based repeated cross-sectional study, of all accidental stimulant toxicity deaths between January 1, 2018, and December 31, 2021, in Ontario, Canada.

Breast Cancers With Intermediate Estrogen Receptor Expression: Characteristics, Prognosis and Treatment.

In the era of personalized oncology biomarkers that identify subgroups of specific cancers and help predict response to specific therapies are critical tools for prognosis determination and therapeutic decisions. The Estrogen Receptor (ER) had been one of the first biomarkers used in breast cancer and has helped advance the field of breast oncology by contributing to the success of hormonal therapies for the ER positive subgroup of the disease. Expression of the receptor in 1% or more of tumor cells in immunohistochemical sections define currently the ER positive subgroup of breast cancers, which may be treated with regimens that include hormonal inhibitors.

Health inequalities in respiratory tract infections - beyond COVID-19.

Purpose Of Review: To discuss recent findings on the global burden of respiratory tract infections in underprivileged populations, highlighting the critical role of socioeconomic factors in the incidence and severity of these diseases, with a particular focus on health disparities affecting Indigenous communities.

Recent Findings: Pulmonary tuberculosis and lower respiratory tract infections, particularly those caused by Streptococcus pneumoniae and respiratory syncytial virus (RSV), continue to disproportionally impact populations in low-income countries and Indigenous communities worldwide. Indigenous children <5 years old bear the highest global burden of RSV infection, reflecting persistent social inequalities between Indigenous and non-Indigenous populations.

Feasibility and Patient Experience of a Pilot Artificial Intelligence-Based Diabetic Retinopathy Screening Program in Northern Ontario.

Purpose: To assess the feasibility, implementation, and patient experience of autonomous artificial intelligence-based diabetic retinopathy detection models.

Methods: This was a prospective cohort study where consenting adult participants previously diagnosed with diabetes were screened for diabetic retinopathy using retinal imaging with autonomous artificial intelligence (AI) interpretation at their routine primary care appointment from December 2022 through October 2023 in Thunder Bay, Ontario. Demographic (age, sex, race) and clinical (type and duration of diabetes, last reported eye exam) data were collected using a data collection form.

Analysis of the top-down HoLEP learning curve: A single-center experience of two clinical fellows.

Introduction: Holmium laser enucleation of the prostate (HoLEP) is known to have a steep learning curve. The top-down technique was introduced to lessen the number of procedures required to master HoLEP. We aimed to present the experiences of two successive clinical fellows with the top-down HoLEP learning curve and compare their performance with the supervisor.

Benefit of Avasopasem Manganese on Severe Oral Mucositis in Head and Neck Cancer in the ROMAN Trial: Unplanned Secondary Analysis.

Purpose: Oral mucositis (OM) is a debilitating side effect of cisplatin and intensity-modulated radiation therapy (IMRT) in patients with head and neck cancer. The phase 3 ROMAN trial showed avasopasem manganese (AVA) significantly decreased individual endpoints of incidence and duration of severe oral mucositis (SOM, World Health Organization [WHO] grade 3-4), with nominal decrease in severity (WHO grade 4) and significant increase in the delay in onset of SOM. We sought to determine the Net Treatment Benefit (NTB) of AVA versus placebo (PBO) using the generalized pairwise comparisons (GPC) method.

Cost-effectiveness analysis of radiofrequency renal denervation for uncontrolled hypertension in Canada.

Aims: Catheter-based radiofrequency renal denervation (RF RDN) is an interventional treatment for uncontrolled hypertension. This analysis explored the therapy's lifetime cost-effectiveness in a Canadian healthcare setting.

Materials And Methods: A decision-analytic Markov model was used to project health events, costs, and quality-adjusted life years over a lifetime horizon.

A "Mismatched" connection: a rare case of indirect or dural carotid-cavernous fistula: a case based review.

Introduction And Importance: A carotid-cavernous sinus fistula is an abnormal connection between the internal or external carotid artery and the venous system of the cavernous sinus. It represents a rare entity, and it is often misdiagnosed due to its overlapping symptoms with other conditions such as cavernous sinus thrombosis or orbital inflammation. Cerebral angiography continues to be the gold standard for diagnosis and surgical planning in patients with CCF, and the endovascular trans-venous approach still represents the primary line of treatment.

Robot-Assisted Cystectomy in Patients With Previous Pelvic Irradiation: A Comprehensive Systematic Review and Single-Arm Meta-Analysis.

To evaluate the perioperative outcomes of robot-assisted cystectomy in previous pelvic irradiation patients. We performed a systematic review with a single-arm meta-analysis, searching the PubMed, Embase, Scopus, and Cochrane databases through July 2024. Included studies reported perioperative outcomes of robot-assisted radical cystectomy in patients with prior pelvic irradiation.

Can all roads lead to competency? School levels effects in Licensing examinations scores.

At the foundation of research concerned with professional training is the idea of an assumed causal chain between the policies and practices of education and the eventual behaviours of those that graduate these programs. In medicine, given the social accountability to ensure that teaching and learning gives way to a health human resource that is willing and able to provide the healthcare that patients and communities need, it is of critical importance to generate evidence regarding this causal relationship. One question that medical education scholars ask regularly is the degree to which the unique features of training programs and learning environments impact trainee achievement of the intended learning outcomes.

Evaluating a transitional housing program for people who use substances (PWUS) who experience homelessness and live with a mental health issue: a mixed-methods study protocol in Sudbury Ontario.

Background: A new transitional housing program was established in Sudbury, Ontario, Canada, in response to the escalating global prevalence of substance use and homelessness, and the specific challenges faced in Northern Ontario. This protocol outlines a comprehensive program evaluation to assess its impact on patient outcomes, healthcare utilization, and client perspectives.

Methods: We will conduct a parallel mixed-method study that includes the analysis of single-center-level administrative health data and primary data collection.

Comparison of physician-delivered models of virtual and home-based in-person care for adults in the last 90 days of life with cancer and terminal noncancer illness during the COVID-19 pandemic.

Objective: To measure the association between types of serious illness and the use of different physician-delivered care models near the EOL during the COVID-19 pandemic.

Design, Setting And Participants: Population-based cohort study using health administrative datasets in Ontario, Canada, for adults aged ≥18 years in their last 90 days of life who died of cancer or terminal noncancer illness and received physician-delivered care models near the end-of-life between March 14, 2020 and January 24, 2022.

Exposure: The type of serious illness (cancer or terminal noncancer illness).

Safety and Efficacy of Deucravacitinib in Moderate to Severe Plaque Psoriasis For Up to 3 Years: An Open-Label Extension of Randomized Clinical Trials.

Importance: Safe and effective long-term treatments for moderate to severe plaque psoriasis are needed.

Objective: To evaluate the long-term safety and efficacy of deucravacitinib through 3 years (week 148) in the randomized POETYK PSO-1, PSO-2, and nonrandomized long-term extension (LTE) trials.

Design, Setting, And Participants: PSO-1/PSO-2 were global, 52-week, randomized, double-blinded phase 3 trials in patients with moderate to severe plaque psoriasis.

Psychological impacts of the Gaza war on Palestinian young adults: a cross-sectional study of depression, anxiety, stress, and PTSD symptoms.

Background: The Gaza Strip has been embroiled in a violent military assault since October 2023, with an immense toll on the civilian population. Armed conflicts threaten the mental health of affected communities and survivors, and psychiatric morbidity increases with forced displacement and with severe and recurrent trauma. This study investigates the prevalence and predisposing factors of depression, anxiety, stress, and PTSD symptoms in a group of young adult students from the Gaza Strip during the war.

Fibromuscular Dysplasia: A Focused Review for the Cardiologist.

Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes. Fibromuscular dysplasia (FMD) is an idiopathic, nonatherosclerotic, and noninflammatory arterial disease that affects small- to medium-sized arteries that can result in multifocal aneurysms, stenosis, tortuosity, and dissections. Extracoronary FMD has been identified in approximately 70% of SCAD patients and it is recommended that all SCAD patients undergo screening for FMD once in their lifetime using computed tomography angiography from head to pelvis.