North York General Hospital (NYGH) is a teaching hospital in Toronto, Ontario, Canada. Primarily serving the North York district, as well as southern York Region, it offers acute care, ambulatory and long-term services at multiple sites. It is one of Canada's leading community academic hospitals and is affiliated with the University of Toronto. NYGH is one of the three constituent hospitals of the Peters-Boyd Academy of the University of Toronto Faculty of Medicine.
Women with unilateral breast cancer continue to choose (unilateral or bilateral) mastectomy. We aim to determine decision regret and its relationship with psychosocial outcomes after breast cancer surgery. We performed a prospective cohort study of women with unilateral, sporadic stage 0-III breast cancer at University Health Network (Toronto, Canada) who underwent unilateral lumpectomy (UL), unilateral mastectomy (UM), or bilateral mastectomy (BM). Unilateral mastectomy was further categorized into oncologically indicated (UMO) versus patient choice (UMC). Participants completed the Decision Regret Scale (DRS), BREAST-Q, Impact of Event Scale, and Hospital Anxiety and Depression Scale at 12 or 18 months after surgery. Univariable and multivariable linear regression models were adjusted for demographic, clinical, and treatment-related factors. P < 0.05 was deemed significant. In total, 217 women were included, including 51 UL, 95 UM (71 UMO, 24 UMC), and 71 BM. There was a difference in DRS scores between UL and UM (8.3 vs. 17.4; P <0.01). Bilateral mastectomy was not associated with higher regret. After adjustment for covariates, UMC remained significantly associated with greater decision regret (β = 16.0, SE = 7.6, P = 0.04). Among women having UMC, women with higher regret had lower scores of breast satisfaction (β = −1.0, SE = 0.5, P = 0.03) and psychosocial well-being (β = −0.8, SE = 0.4, P = 0.02). Decision regret is influenced by surgical procedure in women with unilateral breast cancer. Women who have unilateral mastectomy, particularly those who choose the procedure when eligible for lumpectomy, report higher decision regret and worse breast satisfaction and psychosocial well-being.
BACKGROUND AND OBJECTIVE:The management of muscle-invasive bladder cancer (MIBC) is evolving rapidly with the emergence of new perioperative treatments and approaches for bladder preservation. We provide guidance on clinical staging and optimal therapeutic sequencing for patients with MIBC in clinical practice and within the context of clinical trial design. METHODS:The International Bladder Cancer Group (IBCG) convened global experts in bladder cancer to develop recommendations for the management of MIBC and to guide clinical trial design. Working groups reviewed the literature and developed draft recommendations. This was followed by voting by the IBCG members during a live meeting in August 2024 using a modified Delphi process. Recommendations achieving ≥75% agreement during the meeting were further refined and presented. KEY FINDINGS AND LIMITATIONS:The IBCG recommends thorough clinical staging and multidisciplinary care for patients with MIBC. Contemporary retrospective comparisons suggest that radical cystectomy (RC) and trimodal therapy have similar oncologic efficacy. Patients with pure squamous-cell carcinoma or adenocarcinoma are best managed with upfront RC, while cisplatin-based neoadjuvant therapy before RC is recommended for other histologic subtypes. Risk-stratified adjuvant therapy approaches should be used after RC. There are no currently validated predictive biomarkers to guide clinical decision-making in MIBC outside the context of a clinical trial. The IBCG recommends the use of time-to-event endpoints for perioperative therapy trials, and bladder-intact event-free survival for bladder preservation trials, with an emphasis on incorporating patient-reported quality-of-life endpoints. CONCLUSIONS AND CLINICAL IMPLICATIONS:The IBCG consensus recommendations provide practical guidance on optimal treatment sequencing strategies in the management of MIBC.
Background Unintentional injuries are a major cause of death worldwide. Modern trauma systems have reduced morbidity and mortality through rapid prehospital care, yet trauma research faces challenges obtaining informed consent during emergencies. Because patients are often incapacitated and substitute decision makers are unavailable, studies commonly rely on deferred or waived consent. Despite their use, little is known about public perspectives on these models or on prehospital interventions such as paramedic-administered blood transfusion.Objective To explore Canadian public perspectives on trauma research, alternative consent models, and prehospital blood transfusion.Methods A multi-methods community engagement study, including a national survey and 96 in situ interviews in four rural Ontario communities. Survey and interview questions assessed trust in healthcare, views on research consent, and acceptance of prehospital blood transfusion. Quantitative data were summarized descriptively; qualitative data underwent thematic analysis.Results Survey respondents reported strong trust in the healthcare system (75%) and support for clinical trials (80%). Acceptance of alternative consent was mixed, with only 40% finding it acceptable. Most agreed that data collected before withdrawal of consent should remain usable. Support for paramedic-administered blood transfusion was high (70%), grounded in urgency and trust in paramedic expertise, though concerns included safety and autonomy. Interviews reinforced these themes, emphasizing conditional acceptance of deferred consent, preference for timely communication, and strong trust in paramedics during life-threatening emergencies.Conclusion Canadians support prehospital blood transfusion and recognize the need for trauma research, but acceptance of alternative consent models depends on transparency, perceived necessity, and respect for autonomy.
This survey of the public, pharmacists, and other healthcare professionals identified factors affecting implementation of antibiotic stewardship in Canadian community pharmacies. Lack of support from non-pharmacist healthcare providers and pharmacy leadership were common barriers. Facilitators included providers’ perceived importance of antibiotic stewardship, pharmacists’ role as educators, and potential for healthcare cost savings.
