CARE Canada

Patients are turning to the internet to access educational materials to help them make healthcare decisions, making readability an important factor. This cross-sectional study assessed the readability of online patient education materials for myopia management treatments that have regulatory approval. The top 10 Google search results from May 2024 for freely available online patient information on myopia management modalities and regulatory-approved products in Canada and Australia were analysed for readability. The modalities included orthokeratology, myopia control spectacle lenses, myopia control soft contact lenses and atropine. The products included MiYOSMART® [HOYA®], Stellest® [Essilor®], MyoCare® [ZEISS], MiSight® 1 day [CooperVision®], ACUVUE® Abiliti® 1-Day [Johnson & Johnson], NaturalVue® Multifocal 1 Day [VTI], ACUVUE® Abiliti® Overnight [Johnson & Johnson] and Eikance [Aspen Pharmacare Australia]. These searches gave 120 results. Readability was assessed with Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG) Index and Coleman Liau Index (CLI). Additionally, websites were scored on Journal of the American Medical Association (JAMA) benchmark criteria. Statistical analysis was performed with two-tailed tests. Of 120 websites, none met the recommended sixth-grade reading level across all readability indices. There were 13 websites meeting at least one readability index, 10 being product-related. There were seven websites satisfying all four JAMA benchmarks, while the majority met one. There was a weak positive relationship between product search rank and readability (SMOG p = 0.02, GFI p = 0.02) and a weak negative relationship between JAMA benchmarks and readability for both modality (CLI p = 0.045) and product (CLI p = 0.049). Online information about myopia management is generally written above the recommended sixth-grade reading level and does not meet all JAMA benchmarks. Websites that appear as top search results do not necessarily have easier readability. The readability of online patient education materials may influence access to treatment and outcomes.

Benchmarks are essential to institutional investing, but their dual role—as both strategic references and measures of execution—can create structural tensions. When applied at the asset-class level, benchmarks may inadvertently encourage behaviors such as index tracking, beta tilts, or localized outperformance that do not always align with total fund objectives. This article explores an alternative governance model in which the board anchors the total fund benchmark, while the investment executive (IE)—the CEO, CIO, and their team—designs mandate-level benchmarks. A stylized, game-theoretic model shows that delegation reduces benchmark gaming, supports the generation of uncorrelated alpha, and enables more efficient capital allocation. The expected outcome is stronger risk-adjusted returns, more diversified sources of alpha, and improved retention of top investment talent. With appropriate guardrails and oversight, delegated benchmarking restores benchmarks to their intended role: providing clear accountability for execution in service of long-term total fund success.

In response to COVID-19 related health care access restrictions, telemedicine was introduced to continue to provide necessary health care access in Ontario, Canada. This study examined the role of a telephone assessment (triage) in streamlining referral consultation in patients with low back pain who were referred to a spine specialty surgical clinic. This was an observational study of patients presenting with low back pain with or without leg pain. The virtual interview was conducted by an experienced Advanced Practice Physiotherapist (APP) via telephone. The clinician documented the current symptoms, reviewed referral information including diagnostic imaging and made decisions regarding surgical appropriateness. Patients with cauda equina syndrome, metastatic spinal cord compression lesions, infection and fractures were excluded. Descriptive analysis and general linear modeling were conducted. A consecutive sample of 100 patients, 50 females (average age = 58, SD: 16, range 20-87 years) participated in the virtual assessment. Of 100 participants, 41 (41%) were deemed appropriate to proceed for an in-person assessment, with 36% being considered as potential surgical candidates (33 patients were seen by a spine surgeon and 3 were referred to a hip surgeon for hip arthritis). Fifty-nine (59%) patients did not require an in-person visit to the clinic. The most prominent reason for subsequent surgical assessment was leg dominant pain (neurogenic claudication/radiculopathy) with concordant imaging findings (27, 75%). There was a statistically significant association between surgical candidacy and presence of leg symptoms secondary to disc herniation or claudication (p = 0.0002) with no association with the scores of the PROMs or isolated imaging (P > 0.05). A structured virtual telephone interview was an effective means of triaging patients with LBP with and without leg pain with a potential of reducing the number of unnecessary visits to a spine surgeon. Radicular pain to the lower extremity was the most common symptom among participants who were directed to the surgeon.

Background: The Amputation Reduction and Compassion (ARC) Act of 2023 and 2025 supports arterial duplex ultrasound (DUS) as an initial screening tool to detect and treat peripheral arterial disease (PAD) to reduce amputations. Our prior research found use of DUS in PAD management was associated with higher rates of atherectomy procedures, questionable interventions, and worse surgical outcomes when compared to the use of ankle-brachial index (ABI) with toe-brachial index (TBI). Given DUS’s higher false-positive rate, we hypothesize DUS may be associated with higher vascular complications of claudication, chronic limb threatening ischemia (CLTI), major amputations, and increased endovascular intervention. If confirmed, the ARC Act’s recommendation for DUS may have unintended consequences of patient harm. Methods: Using the TriNetx de-identified database from April 2010–2025, we performed a retrospective cohort study. Inclusion criteria were: a) PAD diagnosis; b) at least one PAD risk factor (diabetes, hypertension, hyperlipidemia, smoking); c) an endovascular procedure (atherectomy, stenting, or angioplasty) performed within two years of both PAD diagnosis and PAD risk factor. Cohorts were assessed for PAD diagnosis by ABI/TBI alone (Cohort A), DUS alone (Cohort B), or both (Cohort C). After propensity score matching for age, gender, and race, we compared Cohorts A-B, A-C, and B-C, to assess for vascular complications, including chronic kidney disease/renal failure and lower extremity CTA, within five years of intervention. Results: Cohort A-B (n=9,180) displayed claudication (RR=1.334, p<0.0001) and re-interventions (RR=1.407, p<0.0001) in Cohort B. Cohort A-C (n=27,833) displayed claudication (RR=2.152, p<0.0001), CLTI (RR=1.687, p<0.0001), amputation (RR=1.286, p<0.0001), lower extremity CTA (RR=1.977, p<0.0001), and re-interventions (RR=1.817, p<0.0001) in Cohort C. Cohort B-C (n=9,683) displayed claudication (RR=1.724, p<0.0001), CLTI (RR=1.487, p<0.0001), amputation (RR=1.385, p<0.0001), lower extremity CTA (RR=1.987, p<0.0001), and re-interventions (RR=1.286, p<0.0001) in Cohort C. After excluding PAD diagnosis as a confounder, major amputation increased (RR=1.156, p<0.0072) in Cohort A. Conclusion: This is the second research group study linking DUS with increased and questionable interventions. These results highlight the risk for greater public harm if DUS is used as a screening tool, as detailed in the 2023 and 2025 ARC ACT.

Family presence during resuscitation (FPDR) represents a vital yet complex aspect of critical care, blending ethical, emotional, and clinical dimensions to enhance family engagement. Although FPDR offers significant benefits, such as fostering closure and transparency, addressing health care providers' concerns about potential disruptions and workflow challenges is essential to its effective and equitable implementation. This article investigated critical care and emergency nurses' perceived risks and challenges of FPDR and barriers to implementing FPDR, as well as suggested measures to enhance the implementation of this care approach. A qualitative descriptive approach was utilized using purposeful sampling to recruit critical care and emergency nurses from Midwestern US hospitals. Participants were interviewed using Zoom. Twenty-one nurses participated, predominantly female, White/non-Hispanic, with 1 to 25 years of experience and mostly bachelor-level education. The study identified 3 themes: risks and challenges of FPDR, barriers to its implementation, and recommendations for its facilitation. Participants highlighted barriers, challenges, and risks to FPDR, alongside facilitators such as institutional support, education, communication training, clear policies, family-related factors, assessment of family readiness, and designating a support person. Addressing these barriers and utilizing facilitators through education and strategic management can improve FPDR awareness and implementation in critical and emergency care.

Purpose: Functional dependence affects well-being and life expectancy. We identified baseline variables that best predict future limitations in basic and instrumental activities of daily living. Method: Using a filtering approach, we selected the best predictors from 4,248 candidate predictors for 39,927 Canadian Longitudinal Study on Aging participants aged 44–88 years and compared machine learning models trained on baseline data (2010–2015) on their ability to classify functional status (independent vs. dependent people) at follow-up (2018–2021) in a training set ( n = 31,941). We then tested the best model in a separate test set ( n = 7,986). Results: Eighteen variables best predicted functional status at follow-up. Logistic regression performed best, achieving 81.9% balanced accuracy in the test set. Protective factors included no baseline limitations, stronger grip, absence of pain or chronic conditions, female sex, having a driver’s license, and good memory. Risk factors included older age, psychological distress, slow walking, retirement, chronic conditions, and physical inactivity. Conclusion: Functional status can be predicted up to 6 years in advance using health, demographic, cognitive, and physical activity variables. Early identification may enable timely interventions to delay functional decline.

Accurate in-hospital length of stay prediction is a vital quality metric for hospital leaders and health policy decision-makers. It assists with decision-making and informs hospital operations involving factors such as patient flow, elective cases, and human resources allocation, while also informing quality of care and risk considerations. The aim of the research reported in this paper is to use survival analysis to model General Internal Medicine (GIM) length of stay, and to use Shapley value to support interpretation of the resulting model. Survival analysis aims to predict the time until a specific event occurs. In our study, we predict the duration from patient admission to discharge to home, i.e., in-hospital length of stay. In addition to discussing the modeling results, we also talk about how survival analysis of hospital length of stay can be used to guide improvements in the efficiency of hospital operations and support the development of quality metrics.

Introduction Lung cancer is the second most commonly diagnosed cancer in Canada and is the leading cause of death in both men and women.The most common causative agent is

With a lack of standard processes in first parenteral dose medication administration in the home and community setting, a quality improvement initiative was undertaken by provincial home and community care service provider organizations (SPOs) in Ontario to support an evidence-based practice approach for administering the first dose of an intravenous (IV) medication. The project group, consisting of clinical leaders and business competitors, united to collaborate and support evidence-based, safe patient care. The group developed an evidence-based approach to screening patients for safe administration of the first dose of a parenteral medication within the home and community setting. Aligning the practice of administering the first dose of a parenteral medication is critical to providing safe, consistent, equitable, and timely care for all patients requiring a first dose in the home and community setting. From the SPO perspective, this improvement initiative has achieved the primary goal of aligning on a consistent patient safety screening tool used to support determining if first dose administration of a parenteral medication in the community is safe for the patient. Outputs of this work include collaborating with the provincial government funder and with SPOs who are competing for the same contracts within this sector, and the development of evidence-based resources to support patient screening. An exciting outcome was the opportunity to align with the Canadian Vascular Access Association (CVAA) and their mission statement of advocating for safe, quality patient care across the healthcare system (CVAA, n.d.). By developing an evidence-based approach to administering the first dose of a parenteral medication, this group has advocated for CVAA to include elements of the quality improvement (QI) initiative within the newly updated 2024 CVAA guidelines. This manuscript outlines the continued and thorough process undertaken by SPOs and the provincial government funder for home and community care to standardize best practices for administering a first dose of a parenteral medication in this unique sector. The successes and challenges encountered in aligning all those with a vested interest are highlighted.