Queen Elizabeth II Health Sciences Centre

BACKGROUND:Apixaban and rivaroxaban are the oral anticoagulants most frequently used to treat acute venous thromboembolism. However, uncertainty remains about the difference in bleeding risk between the two medications. METHODS:In an international trial with a prospective, randomized, open-label, blinded end-point design, we assigned, in a 1:1 ratio, eligible patients with acute symptomatic pulmonary embolism or proximal deep-vein thrombosis to receive apixaban or rivaroxaban for 3 months. Apixaban was given at a dose of 10 mg twice daily for 7 days followed by 5 mg twice daily, and rivaroxaban was given at a dose of 15 mg twice daily for 21 days followed by 20 mg daily. The primary outcome was clinically relevant bleeding, a composite of major bleeding or clinically relevant nonmajor bleeding, as defined according to the International Society on Thrombosis and Haemostasis, during the 3-month trial period. Secondary outcomes included death from any cause. RESULTS:A total of 2760 patients underwent randomization: 1370 to the apixaban group and 1390 to the rivaroxaban group. A primary-outcome event occurred in 44 of 1345 patients (3.3%) in the apixaban group and 96 of 1355 patients (7.1%) in the rivaroxaban group (relative risk, 0.46; 95% confidence interval [CI], 0.33 to 0.65; P<0.001). Death from any cause occurred in 1 patient (0.1%) in the apixaban group and in 4 patients (0.3%) in the rivaroxaban group (relative risk, 0.25; 95% CI, 0.03 to 2.26). Serious adverse events unrelated to bleeding or venous thrombosis occurred in 36 patients (2.7%) in the apixaban group and in 30 patients (2.2%) in the rivaroxaban group. CONCLUSIONS:Among patients with acute venous thromboembolism, the risk of clinically relevant bleeding was significantly lower with apixaban than with rivaroxaban during the 3-month treatment period. (Funded by the Canadian Institutes of Health Research and others; COBRRA ClinicalTrials.gov number, NCT03266783.).

Comprehensive genomic profiling (CGP) is a meaningful advancement in the field of oncology, enabling critical clinical decision-making regarding precision treatments that have biological rationale. In June 2025, the Colorectal Cancer Resource & Action Network (CCRAN) hosted their annual pan-tumour Biomarkers Conference, a virtual meeting of clinicians, scientists, and patients, to discuss recent progress in overcoming barriers to CGP access for patients in Canada with metastatic cancer. The meeting's cornerstone was the presentation of the first national costs and benefits analysis of universal CGP for five metastatic tumour types; findings demonstrated this diagnostic's potential, with the model estimating a gain of 3440 life years while generating $87M-134M of potential healthcare system savings, over a six-year time horizon. Additionally, conference sessions focused on the clinical value of CGP, strategies to leverage the economic analysis results and learn from international experiences, as well as mechanisms to prepare the Canadian healthcare system for future adoption. The conference led to calls to action for a national strategy to reduce disparities in equitable access to CGP, funding allocation for CGP as a standard of care for all patients with metastatic cancer, and pathways to enhance current infrastructure to expedite CGP across the country.

This dual-center study evaluated the impact of artificial intelligence (AI) on urine culture turnaround times in Canadian diagnostic laboratories using microbiology laboratory automation. Data were collected before and after the implementation of PhenoMATRIX (PM), an AI-based software that provides continuous culture sorting and result interpretation support. In both a low-volume tertiary care hospital and a high-volume community laboratory, PM enabled earlier availability of interpretable results; however, reductions in time to result reporting (TTRR) were contingent on workflows for result release. At the tertiary care site, implementation of PM alone was associated with increased TTRR, reflecting delays between result availability and reporting. Integration of PM+ enabled automated release of negative results as they became available, resulting in a TTRR reduction of approximately 1.3 h. At the community laboratory, where PM+ was not implemented, a TTRR improvement of approximately 5.3 h was achieved by advancing manual screening workflows (08:00 vs 16:00), facilitating earlier review and release of PM-generated results. These findings indicate that AI-driven culture assessment reduces TTRR when coupled with processes that enable timely result release, either through automated reporting or optimized laboratory review workflows.IMPORTANCEAdvances in artificial intelligence (AI), coupled with the power of laboratory automation, is the next step in the evolution of the clinical microbiology laboratory. We demonstrated that bacterial culture assessment (urine cultures) by AI decreases the time required to release results to clinicians and reduces the hands-on time required by technologists to analyze and finalize laboratory analysis. This study was performed in two different laboratories that differed not only in geography but also in scope and scale. The same ultimate benefits were seen in both institutions demonstrating that this technology is widely applicable for most laboratories.

As bispecific T-cell engagers (TCEs) gain traction in the oncology treatment landscape, cancer centres must develop robust clinical pathways to ensure their safe and efficient delivery. Given the limited experience of the Canadian medical oncology community with TCEs, collecting and publishing early clinical experiences with these novel agents will be essential to inform best practices and support their safe and effective adoption across the broader Canadian oncology community. The approval of tarlatamab, the first-in-class delta-like ligand 3 (DLL3)-targeted TCE for extensive-stage small cell lung cancer (ES-SCLC), underscores the importance of sharing early clinical experience with this agent, particularly given its unique safety profile, specific monitoring requirements, and use in a population that often has multiple comorbidities. Like other TCEs, tarlatamab is associated with cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), adverse events (AEs) that necessitate the development of dedicated protocols by medical oncologists and multidisciplinary inpatient and outpatient clinical teams to ensure prompt recognition and management of these associated toxicities. By sharing insights into administration protocols, dose ramp-up procedures, post-cycle 1 monitoring, and AE management strategies implemented at their centres, early adopters of tarlatamab can help other institutions develop and refine their own protocols more efficiently. Lessons learned during the early implementation phase, including the roles of various healthcare providers and the transition from inpatient to outpatient care, should facilitate the smoother integration of tarlatamab and other TCEs for solid tumours into clinical pathways across Canada.

Background:Recent research reported that people with type 2 diabetes (T2D) and the haptoglobin (Hp) 2-2 phenotype had reduced coronary artery disease risk with aggressive glycemic targets. Those without the Hp2-2 phenotype did not have this reduction and actually faced increased mortality risk, indicating that using the Hp phenotype test to personalize glycemic targets may be warranted. We aimed to explore the perspectives of individuals with T2D on personalized glycemic targets based on the Hp phenotype test. Methods:In this qualitative descriptive study, we conducted semi-structured interviews that included 2 hypothetical scenarios about the Hp phenotype test with 25 Canadian adults with T2D between July and December 2024. Participants were purposively sampled, and interviews lasted 20-85 minutes. Inductive thematic analysis identified themes. Results:We identified 6 themes, as follows: (i) the Hp phenotype test could provide helpful new information; (ii) the test would not be inconvenient; (iii) test uptake would depend on characteristics of the healthcare provider and the accessibility of healthcare services; (iv) participants have fear that aggressive glycemic targets in the Hp2-2 phenotype may perpetuate stigma from healthcare providers and cause treatment burden; (v) motivation to use knowledge regarding the Hp2-2 phenotype to control blood sugar may be related to one's age, disease progression, and current glycemic target; and (vi) participants have uncertainty in how to use the information that they do not have the Hp2-2 phenotype in managing their T2D. Conclusions:People with T2D were receptive to the concept of the Hp phenotype test and described potential barriers that would need mitigation to optimize clinical utility of the test.