Canadian Setting Research Articles

Analyzing the temporal trends of kidney transplantation surgeries and their impact on warm and cold ischemia time in a Canadian setting.

The effect of weekend admission and surgery on patient morbidity and mortality has been studied in many settings and has been shown to lead to worse outcomes. Several studies have sought to determine whether there is a weekend effect in kidney transplantation specifically, but a clear effect on outcomes and graft survival has not been established. We analyzed data from all deceased-donor organ procurements and cadaveric kidney transplants occurring during the 5-year period between Apr. 1, 2013, and Dec. 31, 2017, included in the database of the Trillium Gift of Life Network, Ontario's organ and tissue donation agency. A total of 1116 deceased donor nephrectomies (DNs) and 1858 recipient procedures were performed in Ontario during the study period. The overall rate of after-hours DNs on weekdays was significantly greater than during working hours (23.1/30 d v. 15.4/30 d, p < 0.001). Donations after neurological determination of death were more frequent during weekday working hours (22.8/30 d) than after hours on weekdays (17.3/30 d, p < 0.001) or weekends (16.3/30 d, p < 0.001), whereas donations after cardiac death were significantly more frequent after hours on weekdays than during working hours (10.3/30 d v. 7.7/30 d, p = 0.021). On weekdays, mean warm ischemia time (WIT) was significantly longer after hours than during working hours (40.75 ± 12.26 min v. 38.52 ± 11.92 min, p = 0.017). Similarly, mean WIT was longer after hours than during working hours on weekends (40.23 ± 12.48 min v. 38.59 ± 11.91 min, p = 0.015). Kidney transplantations occurred more frequently after hours and were associated with increased WIT. Further study is needed across multiple Canadian centres to better understand the temporal patterns of kidney transplantation and implications for patients, providers, and health care systems.

Clinical Outcomes and Cost Implications of a Community Psychosocial Rehabilitation Service for Severe and Persistent Mental Illness in Nova Scotia, Canada.

Introduction: Individuals with severe and persistent mental illness (SPMI) present distinct challenges in mental healthcare due to the chronic and complex nature of their conditions. This study was conducted to assess the clinical efficacy and potential cost-effectiveness of a multidisciplinary community-based psychosocial rehabilitation team serving individuals with SPMI in Nova Scotia, Canada. Method: This study was conducted to evaluate the effects of a community-based psychosocial rehabilitation program on individuals with severe and persistent mental illness (SPMI) in Nova Scotia, Canada. This research focused on clinical outcomes and potential cost savings following a one-year intervention, offering critical insights into the benefits of community-based care for this population. A cohort of 137 clients accepted into the community rehabilitation service (Connections Dartmouth) between September 2016 and September 2020 was analyzed. Each participant received one year of community rehabilitation intervention. Using data from the Canadian Medical Service Insurance (MSI) billing system, this research compared the use of inpatient services and Emergency Department visits in the year prior to and the year following the intervention. The findings provide valuable evidence on the role of community rehabilitation in reducing healthcare utilization for individuals with SPMI. Results: The results demonstrated a statistically significant reduction in mean admission rates and length of inpatient admissions in the year following rehabilitation compared to the pre-rehabilitation year. A substantial percentage of patients experienced no inpatient admissions (88% vs. 60%) or Emergency Department visits (82% vs. 67%) in the post-rehabilitation year, compared to the pre-rehabilitation year. There was a significant reduction in inpatient days by 90%, translating into substantial cost savings. The findings highlight the potential economic benefits of community rehabilitation for people with SPMI. Conclusions: This uncontrolled study suggests that community rehabilitation is associated with positive clinical outcomes for individuals with SPMI in terms of reduced inpatient service use and associated costs. Further research, including controlled studies and cost-effectiveness studies, into the community psychosocial rehabilitation services in the Canadian setting is needed.

Road to Recovery: protocol for a mixed-methods prospective cohort study evaluating the impact of a new model of substance use care in a Canadian setting

IntroductionThe Road to Recovery (R2R) Initiative is an innovative model of substance use care that seeks to increase treatment capacity by creating approximately 100 new addiction treatment beds to provide...

A Missed Opportunity: Evaluating Immunization Status and Barriers in Hospitalized Children.

Hospitalized children are a potentially underimmunized population. We sought to determine the proportion of patients admitted to our pediatric medicine inpatient units who are underimmunized or unimmunized and to identify barriers to immunization faced by families of children admitted to hospital. We conducted a prospective study of children aged 2 months to 18 years admitted to our pediatric medicine inpatient units between July 2021 and October 2022. Immunization and demographic data were collected from electronic medical charts. Immunization status of each child was categorized as up-to-date if they had received all eligible vaccine doses in accordance with the provincial immunization schedule. Caregivers completed a survey on barriers to immunizations; results were compared between caregivers of children whose vaccines were up-to-date and those who were not. Hospitalized children were missing more doses of the preschool vaccines than the general population based on published provincial data. Only 142 of 244 (58.2%) of study patients were up-to-date on all their immunizations. Caregivers of children whose immunizations were not up-to-date reported significantly more barriers to vaccination in all survey categories: access to shots, concerns about shots, and importance of shots. There is a disparity in immunization status between children admitted to hospital in a Canadian setting compared with national targets and community immunization rates. Caregivers of underimmunized hospitalized children cited significantly more barriers to immunization when compared with hospitalized children who are up-to-date. Pursuing a hospital-based immunization strategy could lead to improved immunization status for hospitalized children.

Review of CAR T-Cell Therapy in Multiple Myeloma: A Canadian Perspective.

Multiple myeloma (MM) is an incurable plasma cell malignancy. In the context of the current standard of care therapies in Canada, outcomes among patients with relapsed/refractory multiple myeloma (RRMM), particularly those with triple-class (or more) refractory disease remain poor. Immunotherapies have significantly changed the treatment landscape of MM. Since 2021, two BCMA-targeting CAR T-cell therapy products have been approved for RRMM-namely Idecabtagene vicleucel (Ide-cel) (ABECMA®) and Ciltacabtagene autoleucel (Cilta-cel) (CARVYKTI®), both of which are available in the US and Europe. Although they have shown unprecedented efficacy in RRMM, their clinical and logistical limitations must be acknowledged. MM CAR T-cell therapy is likely to be approved in Canada soon. Therefore, it is timely that we review the latest evidence for commercially available CAR T-cell therapy in multiple myeloma, with a focus on its relevance and impact in the Canadian setting. There will be challenges to access and strategies must be in place to ensure equitable care for all Canadians with MM. Alongside haematologists working in the immune effector cell therapy programs, providers in the community will also play a role in the ongoing monitoring and management of long-term side effects including opportunistic infections and late neurotoxicity.

Clinical outcomes and characterization of intraocular foreign body injuries from a Canadian centre: a 20-year retrospective study and literature review

To analyse assessment and management patterns of intraocular foreign body (IOFB) injuries in an urban Canadian setting, providing valuable clinical insights to contextualize management. Single-surgeon retrospective chart review from January 2002 to January 2023 examining IOFB patient demographics, investigations, treatments, complications, and best-corrected visual acuity (BCVA). This study evaluated IOFBs in 32 eyes from 31 patients (96.8% male). Sizes ranged from 1 to 12 mm; 28 (87.5%) were metallic and 15 (46.9%) were work-related injuries. For diagnosis, 19 patients (61.3%) underwent computed tomography (CT) imaging, and 8 (25.8%) received B-scans, with CT detecting IOFBs in 100% of cases and B-scan in 87.5%. At final follow-up, 17 eyes (53.1%) achieved BCVA ≥20/40, up from 7 (23.3%) initially. Presenting BCVA ≥20/200 was associated with a final BCVA ≥20/40 (P = 0.027). The IOFB was extracted in 27 eyes (84.4%), retained in 4 (12.5%), and 1 (3.1%) required enucleation. Intravitreal antibiotics were administered in 19 eyes (59.4%), resulting in one presumed case of drug toxicity. Complications were present in 30 eyes (93.8%), totalling 119 recorded overall, with 72 (60.5%) occurring within the first 24 hours. Traumatic cataracts were most common in 27 eyes (84.4%). Less-common complications included siderosis and retinal detachment with proliferative vitreoretinopathy, each occurring in one eye (3.1%). Four eyes (12.5%) developed secondary glaucoma, with 3 cases in retained or delayed extractions. The IOFB characteristics and patient demographics are consistent with other regions. CT scans were the most effective investigation tool. Extended follow-up is recommended to monitor complications, particularly in retained or significantly delayed extractions.

MEASURING BIRTH OUTCOMES: VALIDATING THE PERINATAL OUTCOME INDEX

We undertook a study to assess the reliability and validity of a new measure of low risk maternity care. A Perinatal Outcome Index (POI), which combines intrapartum process of care and clinical outcome items into a summary index score, was originally developed and evaluated in the Netherlands. It was designed to measure the extent to which a labour and birth are "optimal", that is, one with minimal intervention resulting in a healthy mother and a healthy baby. We modified the Dutch index to make it applicable to a Canadian setting. A panel of experts who were not connected with the study reviewed the modified version for applicability, feasibility of obtaining data easily, and content validity. Data were abstracted from the health records of 324 women in one hospital and two midwifery practices to obtain Perinatal Outcome Index scores and examine aspects of construct validity. We measured the inter-rater reliability of the research assistants who abstracted information. The panel achieved consensus on all items in the modified Perinatal Outcome Index to establish content (face) validity. Labour and birth data were readily obtained from health records with high inter-rater reliability (Kappa 0.78). In a linear regression model, birth at home, multiparity, and having a midwife or family physician as a care provider were significantly associated with higher scores (having a more optimal birth) and accounted for 37% of the score variance. The Perinatal Outcome Index has satisfied our expectations for content and construct validity. Research assistants found it easy to use and data items were readily available from women's health records. Inter-rater reliability was acceptable. We believe the modified index will be useful for comparative studies among women at low or average risk, and for quality assurance programs.

After the Unexpected: Ontario Midwifery Clients’ Experiences of Postpartum Hemorrhage

Background: The incidence of postpartum hemorrhage (PPH) varies worldwide. While there is abundant research to guide midwifery practice regarding the acute clinical management of PPH, there is less known about the psychological needs of clients and families following significant blood loss during birth, and no relevant research conducted in a Canadian setting. Methods: Analysis of qualitative data was conducted based on data from two focus groups and two online surveys with participants who had received midwifery care during at least one pregnancy and had experienced at least one PPH. Objective: The goal of this research was to describe the experiences of midwifery clients in Ontario who had suffered a PPH and to compare those findings to what is documented in existing literature. Findings: This study found a range of physical and emotional responses to the experience of PPH, ranging from no effect to short- or longer-term psychological trauma, which is consistent with a small but growing body of international studies. While the risk of delayed lactogenesis increases with PPH, most participants in this study reported no breastfeeding concerns. This study is unique in reporting on creative strategies families developed to cope with PPH. This article has been peer reviewed.

Is tax-related information value relevant? Empirical study in the Canadian setting

PurposeThis study aims at examining the value relevance of tax-related information in Canada. Tax-related information in this study includes taxable income, tax aggressiveness, and tax risk (i.e., unsustainable tax planning).Design/methodology/approachThis study analyzes the Canadian listed firms covering the period of 2012–2021 using the Feltham–Ohlson valuation model.FindingsThe findings are: (1) taxable income provides incremental value relevance information; (2) tax risk reduces the value relevance of both taxable income and accounting income and (3) tax aggressiveness reduces the value relevance of accounting income but not of taxable income. Further tests show that the COVID-19 pandemic increases the value relevance of taxable income but decreases the value relevance of accounting income. An analysis of the association between stock price volatility and tax-related information documents that taxable income and accounting income are both informative. Tax risk reduces the informativeness of taxable income, but tax aggressiveness and the pandemic do not.Research limitations/implicationsThe sample in this study covers the period up to 2021. Future research could use more recent data. Additionally, this study examines the Canadian setting. The results may not be generalized to other countries that have different accounting and tax rules.Originality/valueThis study sheds light on whether tax aggressiveness and tax risk affect the value relevance of taxable income and accounting income separately. In addition, to our knowledge, this is the first study that examines whether tax-related information is informative about stock price volatility.

Real-World Treatment Patterns and Clinical Outcomes among Patients Receiving CDK4/6 Inhibitors for Metastatic Breast Cancer in a Canadian Setting Using AI-Extracted Data.

Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) are widely used in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2 negative (HER2-) advanced/metastatic breast cancer (ABC/MBC) in first line (1L), but little is known about their real-world use and clinical outcomes long-term, in Canada. This study used Pentavere's previously validated artificial intelligence (AI) to extract real-world data on the treatment patterns and outcomes of patients receiving CDK4/6i+endocrine therapy (ET) for HR+/HER2- ABC/MBC at Sinai Health in Toronto, Canada. Between 1 January 2016 and 1 July 2021, 48 patients were diagnosed with HR+/HER2- ABC/MBC and received CDK4/6i + ET. A total of 38 out of 48 patients received CDK4/6i + ET in 1L, of which 34 of the 38 (89.5%) received palbociclib + ET. In 2L, 12 of the 21 (57.1%) patients received CDK4/6i + ET, of which 58.3% received abemaciclib. In 3L, most patients received chemotherapy (10/12, 83.3%). For the patients receiving CDK4/6i in 1L, the median (95% CI) time to the next treatment was 42.3 (41.2, NA) months. The median (95% CI) time to chemotherapy was 46.5 (41.4, NA) months. The two-year overall survival (95% CI) was 97.4% (92.4, 100.0), and the median (range) follow-up was 28.7 (3.4-67.6) months. Despite the limitations inherent in real-world studies and a limited number of patients, these AI-extracted data complement previous studies, demonstrating the effectiveness of CDK4/6i + ET in the Canadian real-world 1L, with most patients receiving palbociclib as CDK4/6i in 1L.

Plagues in Our Criminal Justice System

This study compared the causes of wrongful convictions in Canada, the United States, the United Kingdom, Australia, and New Zealand to a) determine the main causes of wrongful convictions in different countries, b) determine if the cause(s) of wrongful convictions significantly differ between each country, c) determine what, if any, recommendations arose from these cases, and d) if any of these recommendations could be implemented in a Canadian setting. The main causes were witness perjury, forensic error, and procedural error (Canada), witness perjury (US), witness perjury and police misconduct (UK), police misconduct (Australia), and procedural error (New Zealand). Kruskal-Wallis tests indicated significant differences in distribution between these countries for medicolegal death investigations, bitemark analysis, procedural error, police misconduct, inadequate legal defence, eyewitness misidentification, and witness perjury. Objectives c and d were addressed through a content analysis resulting in the following five themes emerging: lack of accountability, education, accessibility, discrimination, and post exoneration.

Perceptions of provider awareness of traditional and cultural treatments among Indigenous people who use unregulated drugs in Vancouver, Canada

IntroductionIndigenous people who use unregulated drugs (IPWUD) face significant barriers to care, including sparse availability of culturally safe health services. Integrating Indigenous traditional and cultural treatments (TCT) into health service delivery is one way to enhance culturally safe care. In a Canadian setting that implemented cultural safety reforms, we sought to examine the prevalence and correlates of client perceptions of primary care provider awareness of TCT among IPWUD.MethodsData were derived from two prospective cohort studies of PWUD in Vancouver, Canada between December 2017 and March 2020. A generalized linear mixed model with logit-link function was used to identify longitudinal factors associated with perceived provider awareness of TCT.ResultsAmong a sample of 507 IPWUD who provided 1200 survey responses, a majority (n = 285, 56%) reported their primary care provider was aware of TCT. In multiple regression analyses, involvement in treatment decisions always (Adjusted Odds Ratio [AOR] = 3.6; 95% confidence interval [CI]: 1.6–7.8), involvement in treatment decisions most or some of the time (AOR = 3.3; 95% CI: 1.4–7.7), comfort with provider or clinic (AOR = 2.7; 95% CI: 1.5–5.0), and receiving care from a social support worker (AOR = 1.5; 95% CI: 1.0–2.1) were positively associated with provider awareness of TCT.ConclusionWe found high levels of perceived provider awareness of TCT and other domains of culturally safe care within a cohort of urban IPWUD. However, targeted initiatives that advance culturally safe care are required to improve healthcare and health outcomes for IPWUD, who continue to bear a disproportionate burden of substance use harms.

Cost-Effectiveness of Respiratory Syncytial Virus Vaccines for Adults

&#x0D; Three economic evaluations and 1 summary of economic evaluations were identified that assessed the cost-effectiveness of 2 respiratory syncytial virus (RSV) vaccines of interest (RSVPreF3 [Arexvy] and RSVpreF [Abrysvo]) compared with no intervention in older adults residing in high-income countries. No economic evaluations assessing mRNA-1345 were identified. No publications investigating RSV vaccination in adults aged 59 years or younger were identified.&#x0D; &#x0D; In total, 5 economic evaluations for RSV vaccines in adults were identified.&#x0D; Four economic evaluations were conducted in the US and 1 was conducted in Hong Kong. All results were presented in terms of incremental cost-utility ratios (i.e., incremental cost per quality-adjusted life-years gained). Net cost per outcome averted was reported for 1 economic evaluation, and cost per hospitalization averted was reported for 3 economic evaluations.&#x0D; The results of all publications found that RSVPreF3 (Arexvy) and RSVpreF (Abrysvo) were more costly and more effective than no intervention for RSV-associated disease. All publications reported that vaccinating older adults against RSV disease was potentially cost-effective. All publications noted that the cost-effectiveness was dependent on vaccine cost, vaccine efficacy, the waning of vaccine protection, RSV hospitalization incidence, health care unit costs, and respective regional willingness-to-pay thresholds.&#x0D; &#x0D; &#x0D; The generalizability of the identified economic evaluations may be limited because the study settings were notably different from Canada. To estimate the cost-effectiveness of RSV vaccinations in Canada, a de novo economic evaluation conducted from a Canadian setting comparing RSVPreF3 (Arexvy), RSVpreF (Abrysvo), and mRNA-1345 is required.&#x0D;

A157 ASSOCIATION OF SUBMUCOSAL INVASION WITH THE PARIS CLASSIFICATION OF POLYPS IN THE LOWER GASTROINTESTINAL TRACT

Abstract Background Endoscopic evaluation of the colorectum allows for diagnosis of colorectal cancer (CRC) and advanced polyps. In particular, polyps can be described in terms of gross morphology using the Paris classification. Previous work has demonstrated that submucosally invasive (SMI) cancer may correlate with the Paris classification subtypes. Aims To determine whether the Paris classification is associated with SMI in a Canadian setting. Methods We conducted a retrospective single-centre study using data from 2016 to 2023 of patients with colorectal lesions that were referred for endoscopic submucosal dissection (ESD). Using the Paris classification, we classified polyps as either protruding type (0-I) or flat type (0-IIa, 0-IIb, 0-IIc, 0-III) lesions. Protruding type lesions were further classified as sessile (0-Is), pedunculated (0-Ip) and pseudo-pedunculated (0-Isp) subtypes. Mixed lesions, with two concomitant subtypes, were categorized using the higher classification subtype. We categorized polyps as: protruded lesions, including any mixed lesions with a flat lesion; isolated flat elevated lesions; and flat lesions, both mixed and isolated lesions. We also recorded polyp location, prior endoscopic mucosal resection (EMR), previous biopsy, and polyp diameter (in cm), age, sex, and American Society of Anesthesiology (ASA) class. The primary outcome was SMI as identifed on histopathology. We used logistic regression with backward stepwise entry, Fisher exact test with relative risk (RR) and 95% confidence interval (95% CI), and independent samples t-test. Statistical tests were two-tailed and significant at Pampersand:003C0.05. Results In our sample of 130 patients, the mean age was 69.2 years (standard deviation [SD] 10.4), most were male (n=78, 60%), and typically had an ASA score of 3 (n=77, 59.2%). Most polyps occured in the rectum (n=65, 50%) with a mean length was 4.5 cm (SD 2.2 cm). The most common subtype was IIa (n=59, 45.4%). Starting with the covariates of age, sex, ASA, prior EMR, prior biopsy at the same, and length of polyp, the logistic regression model reduced them to three: prior EMR, prior biopsy at the same site, and length. Univariate analysis of these three variables found that there was no significant difference with polyp length and SMI (P=0.147) and no significant association with prior EMR on SMI (RR=0.8 [95% CI 0.3 to 1.9]. The presence of prior biopsies at the same site of the lesions was significantly associated with SMI (RR=2.4 [95% CI 1.2 to 4.7]) Conclusions We did not find that the Paris classification for type of polyp lesion did not correlate with the presence of submucosal invasion, nor did prior EMR, age, sex, or length of polyp. The presence of a prior biopsy, however, did in fact tend to predict submucosal invasion. Future work should aim to incorporate mortality data and response to treatment into the above analysis. Funding Agencies None

A149 SAFETY AND EFFICACY OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR ESOPHAGOGASTRIC NEOPLASMS IN A CANADIAN SETTING

Abstract Background Endoscopic submucosal dissection (ESD) is a technique that has been developed in Japan and is increasingly being adopted by western countries for treatment of superficial gastrointestinal neoplasms. Aims In this study, we aim to present the safety and efficacy of ESD for esophageal and gastric neoplasms in a Canadian setting, given the limited data regarding the outcomes of ESD in North America Methods Data of 100 patients with superficial upper GI neoplasms (esophageal and gastric) who underwent ESD between 2016 and 2022 in Kingston Health Sciences Centre, a tertiary hospital in Kingston, Ontario, were retrospectively reviewed. Demographics and lesion characteristics, ESD technique, and outcomes in terms of efficacy and safety were analyzed. Results 100 patients were included in the study. 67% of the lesions were esophageal. The median diameter was 4.6cm and median area was 11.94cm2. Outcomes were favorable with technical success 98%, en bloc resection 96%, R0 resection 89% and curative resection 80%. Upstage in pathology from index biopsy was seen in 42% of the lesions. Adverse events were infrequently encountered (8%) and included delayed bleeding, aspiration, and pain. Conclusions ESD is a safe and effective modality for accurately diagnosing and treating early and superficial esophagogastric neoplasms when performed by trained endoscopists. Further research is required, however, to increase the adoption of this technique across Canada. Procedural Details Funding Agencies None

The impact of robotic rectal cancer surgery at a Canadian regional cancer centre: a retrospective cohort study.

Although robotic surgery has several advantages over other minimally invasive surgery (MIS) techniques for rectal cancer surgery, the uptake in Canada has been limited owing to a perceived increase in cost and lack of training. The objective of this study was to determine the impact of access to robotic surgery in a Canadian setting. We conducted a retrospective cohort study involving consecutive adults undergoing surgical resection for rectal cancer between 2017 and 2020. The primary exposure was access to robotic surgery. Outcomes included MIS utilization, short-term outcomes, total cost of care, and quality of surgical resection. We completed univariate and multivariate analyses. We included 171 individuals in this cohort study (85 in the prerobotic period and 86 in the robotic period). The 2 groups had similar baseline characteristics. A higher proportion of individuals underwent successful MIS in the robotic phase (86% v. 46%, p < 0.001). Other benefits included a shorter mean length of hospital stay (5.1 d v. 9.2 d, p < 0.001). The quality of surgical resection was similar between groups. The total cost of care was $16 746 in the robotic period and $18 808 in the prerobotic period (mean difference -$1262, 95% confidence interval -$4308 to $1783; p = 0.4). Access to robotic rectal cancer surgery increased successful completion of MIS and shortened hospital stay, with a similar total cost of care. Robotic rectal cancer surgery can enhance patient outcomes in the Canadian setting.

The impact of marginalization on diffuse large B-cell lymphoma overall survival: a retrospective cohort study

The aim of this study was to describe the impact of marginalization on DLBCL overall survival (OS) within the Canadian setting. We conducted a population-based retrospective cohort study of adult patients with newly diagnosed DLBCL in Ontario between 1 January 2005 and 31 December 2017 receiving a rituximab-containing chemotherapy regimen with curative intent followed until 1 March 2020. Our primary exposure of interest was the Ontario Marginalization Index (ON-Marg). The primary outcome was 2-year OS, accounting for patient age, sex, cancer characteristics, comorbidity burden, and rural dwelling status. While two-year overall survival was inferior for individuals in the most deprived marginalization quintile (70.4% Q5 vs. 76.0% Q1), after adjustment for relevant covariates neither the composite ON-Marg nor any of its dimensions had a significant effect. Within the Canadian context, among patients who receive chemotherapy, marginalization may not have a significant association with overall survival when accounting for key patient covariates, lending support for preserved outcomes.

The FASTER-BUP Study, Extended-Release Injectable Buprenorphine for the Treatment of Opioid Use Disorder Among Individuals at High Risk of Overdose: Protocol for an Observational Prospective Study.

North America is facing an unprecedented public health emergency of opioid-related morbidity and mortality. The mortality benefits of oral medication treatment for opioid use disorder (MOUD), such as methadone or buprenorphine, are well documented. However, barriers to access and long-term engagement have prevented maximizing their benefits. Long-acting injectable buprenorphine formulations were developed to address some of the challenges associated with oral MOUD. The "Pilot study to assess the feasibility, efficacy, and safety of extended-release injectable buprenorphine for the treatment of opioid use disorder among individuals at high risk of overdose" (FASTER-BUP) was developed to explore this treatment option in populations at high risk of overdose in a real-world Canadian setting. FASTER-BUP is a 24-week observational prospective study evaluating the feasibility and clinical utility of extended-release injectable buprenorphine (XR-BUP) for the treatment of opioid use disorder (OUD) among 40 adults at high risk of overdose (ie, lifetime history of overdose or a positive urine drug test (UDT) for fentanyl within 30 days prior to screening) in Vancouver, BC. The primary outcome is retention in treatment and secondary outcomes include: use of unregulated opioids, safety, overdose events, treatment satisfaction, changes in drug-related problems, changes in quality of life, opioid cravings, health service utilization, and criminal activity. FASTER-BUP is the first study to explore XR-BUP among individuals at high risk of overdose in a real-world Canadian setting. This commentary provides a brief narrative about the study thus far and presents insights on key adaptations to the study protocol, including those adopted to mitigate recruitment challenges.

The Art and Politics of Participant-Driven Photo-Elicitation With Muslim Immigrant Older Women

Photo elicitation is a powerful data collection tool that involves using photographs within an interview encounter to articulate, expand on and uncover experiences of the social world. Between 2020 and 2022, 41 Muslim immigrant older women between the ages of 54 and 85 were recruited via community liaisons in an Urban Canadian setting to participate in a qualitative descriptive photo elicitation study on social connectedness. We explore methodological and ethical considerations of using photo elicitation in narrative interviews with Muslim older women with a focus on: (1) selection and access to photographs, (2) informed consent, (3) shared meaning-making, (4) politics of a photograph, and (5) digital opportunities within a pandemic. The discussion highlights the ways gender, age and religion intersect to influence decision-making during research activities.

Roadmap of Portable MRI Implementation in a Northern Canadian Setting - Lessons Learned from the Moose Factory Experience

1. Review the potential benefits of portable MRI use in a Northern Canadian setting. 2. Describe the challenges of portable MRI implementation in a resource-limited Canadian healthcare environment. 3. Provide guidance to portable MRI implementation at other Canadian and international sites.