Sinai Health System

Palliative care is essential yet underutilized in Canada. Inconsistent definitions and fee codes across provinces/territories hinder effective comparative analysis. Explore palliative care definitions and fee codes in Canada by examining the provincial/territorial schedules of benefits. We conducted a narrative review of provincial/territorial schedules of benefits, focusing on palliative care definitions and fee codes. Qualitative comparative analysis was performed on the definitions, and descriptive statistical analysis was conducted on the fee codes. The study reviewed schedules of benefits from 11 Canadian provinces and territories, excluding Quebec and Nunavut. About 7/11 (64%) provinces/territories published definitions for palliative care, typically characterizing it as terminal, focusing on comfort, and providing a time-based prognosis. The number of specific palliative care fee codes varied from 4 to 32. There is substantial variability in the definition and fee codes used for physician-delivered palliative care across Canada. A standardized national framework for palliative care definitions and fee codes could improve access and care delivery.

Internal hemipelvectomy is a challenging procedure often complicated by wound healing issues. To guide surgical planning and reduce risk of wound complications, we created and validated a preoperative risk stratification model. We reviewed clinical, surgical, and pathological data from 411 patients who underwent en bloc internal hemipelvectomy for malignant pelvic tumors between 1996 and 2018. The sample included a training set (N=123) from a U.S. tertiary hospital and a validation set (N=288) from centers in Canada and the Netherlands. Using logistic regression, we identified key predictors of wound complications requiring surgical intervention and developed a risk scoring system incorporating Enneking-Dunham resection type and tumor anatomic compartment extension. Patients were stratified into three risk categories: low (0-8 points), intermediate (9-13 points), and high (≥14 points). Wound complications requiring surgery occurred in 34% of the training cohort and 35% of the validation cohort. In the training cohort, rates of wound complications were 7.4%, 40%, and 67% in the low-, intermediate-, and high-risk groups, respectively (p<0.001); rates were similar in the validation cohort (7.1%, 32%, and 49%; p<0.001). The risk model demonstrated fair-to-good discriminative performance; the areas under the receiver operating characteristic curves were 0.83 (training cohort) and 0.71 (validation cohort) despite heterogeneity in tumor histology, reconstruction techniques, and perioperative management. We present the first externally validated prognostic staging system for predicting wound complications after internal hemipelvectomy. The model is simple, reproducible, and clinically applicable, allowing surgeons to preoperatively identify high-risk patients who may benefit from modified surgical approaches or prophylactic soft-tissue reconstruction. Further prospective studies are warranted to optimize management strategies for intermediate- and high- risk patients. Prognostic studies, Level III.

Qualitative research in health equity contexts relies on trust, authenticity, and careful interpretation of lived experiences. Yet underrepresented communities, racialized individuals, people with disabilities, and those experiencing socioeconomic marginalization have often been excluded or superficially engaged, reinforcing structural inequities. Participant misrepresentation, including inaccurate demographics or inconsistent narratives, often reflects systemic forces such as racism, economic precarity, and historical mistrust rather than individual deceit. Using intersectionality and community-based participatory research, we illustrate how recruitment, screening, and data collection intersect with participants’ lived experiences. We offer recommendations, including co-developed eligibility, community verification, reflexivity, and culturally responsive engagement, to uphold rigor, trust, and participant well-being.

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

People living with HIV navigate complex medical and social challenges that impact engagement in care, including stigma, poverty and systemic inequities. Patient navigation has emerged as a promising approach to improve linkage, retention and adherence across the HIV care continuum. While evidence suggests that navigation enhances care engagement and health outcomes, little is known about how these programs are implemented in real-world settings, particularly with respect to equity. This scoping review mapped the literature on the implementation of HIV patient navigation programs, with attention to program components, barriers, facilitators and equity considerations. Following the Joanna Briggs Institute framework and PRISMA-ScR guidelines, we searched six databases (MEDLINE, Embase, PsycINFO, JBI, Scopus, Web of Science) and identified 31 eligible studies (2000-2025). Data extraction and synthesis were guided by the Consolidated Framework for Implementation Research (CFIR) and PROGRESS-Plus. Most programs were based in the United States, with others in Africa and Latin America. Navigation was delivered by professionals (35%), peers (35%), or both, with interventions spanning 6-12 months and often including psychosocial support, care coordination and linkage to social services. Facilitators included navigator accessibility, cultural responsiveness and organizational support, while barriers involved system fragmentation, limited funding and structural inequities. Few studies explicitly operationalized equity within implementation strategies. Navigation programs were associated with improvements in ART adherence, care engagement and psychosocial well-being. Findings underscore the importance of embedding equity frameworks into navigation design to ensure sustainable, person-centered models of HIV care that address the needs of marginalized populations.

Interleukin-6 (IL6) signaling plays a key role in inflammation and cardiovascular disease, but its causal effect on long-term mortality remains unclear. We aimed to assess whether genetically proxied levels of IL6, soluble IL6 receptor (IL6R), C-reactive protein (CRP), and growth differentiation factor-15 (GDF15) exert causal effects on long-term all-cause mortality, and to examine potential opposing effects of IL6 and IL6R. We conducted Mendelian randomization (MR) using genome-wide association study instruments from >750,000 individuals. The primary outcome was all-cause mortality over a median follow-up of 11.7 years. Secondary outcomes included cardiovascular events and selected non-cardiovascular conditions. Multiple sensitivity analyses were applied to evaluate robustness and directionality. Genetically higher IL6R levels were associated with reduced mortality (odds ratio (OR) per 1-SD increase: 0.95; 95% CI: 0.91-0.98, p = 0.007) and lower risk of atrial fibrillation, coronary artery disease, stroke, and lung cancer. Conversely, higher IL6 levels were linked to increased mortality (OR: 1.05; 95% CI: 1.02-1.08, p = 0.002). No significant causal effects were observed for CRP or GDF-15. All findings were consistent across sensitivity analyses. IL6 and IL6R appear to be biologically opposing causal regulators of human survival: IL6 increases, while IL6R reduces mortality through cardiovascular mechanisms. CRP and GDF15 likely reflect disease risk rather than drive it. These results support IL6R antagonism as a potential strategy for cardiovascular disease prevention.