Cerebral visual impairment (CVI) is a common sequela of early life brain injuries and can affect participation in daily life activities such as ambulation, social interactions and school engagement. CVI care requires a multidisciplinary healthcare team to support the child and family, but best practices remain undefined. We sought to explore the perspectives of healthcare providers in the assessment and treatment of CVI in Alberta, Canada.

Online surveys were used to inquire about challenges affecting the provision of CVI care. Scores from 5-point Likert scale questions were compared between professions using t-tests. Open-ended questions were coded with themes generated using content analysis.

Fifty-four healthcare providers completed the survey (87%), including pediatric neurologists, pediatric ophthalmologists and allied health (AH) team members. Half reported low confidence in CVI screening, with AH levels lower than those of physicians (p = 0.003). Over 60% described inadequate communication pathways between teams, and 50% described a lack of clarity in CVI referral processes. Open-ended questions highlighted a need for standardization of CVI assessment and treatment (unclear referral pathways, communication challenges between team members) and resource challenges (access to specialized staff and support personnel, insufficient time for assessment and lack of physical resources).

Many interdisciplinary team members in a provincial universal health care system describe current assessment and treatment processes for CVI as unclear, lacking in efficient referral pathways and do not feel adequately resourced to meet the needs of affected children and families.

The impact of inter-hospital transfer before endovascular thrombectomy (EVT) on short-term outcomes has been reported, but its effect on long-term outcomes remains unclear. We examined long-term clinical outcomes after EVT, stratified by whether patients underwent inter-hospital transfer.

We conducted a population-based cohort study using linked administrative data from Ontario, Canada (2017–2023). We included all community-dwelling residents hospitalized with acute ischemic stroke who received EVT. Inter-hospital transfer was defined as any transfer from a non-comprehensive stroke center (CSC) to a CSC before EVT. The primary outcome was all-cause mortality at maximum follow-up, assessed using propensity score-weighted hazard ratios.

Of 68523 ischemic stroke patients, 5394 (7.9%) underwent EVT, with 42.9% transferred before EVT. Direct-to-CSC patients were older, had higher rates of atrial fibrillation and dyslipidemia and were more likely to reside in urban areas. Propensity score-weighted analysis comparing transferred versus direct-to-CSC patients showed no difference in all-cause mortality, but the hazard ratio varied over time, violating the proportional hazards assumption. Transfer was associated with higher early mortality than direct-to-CSC, which declined over time, with mortality lower after 6.3 months, remaining below 1 over prolonged follow-up out to 34.6 months. Transferred patients were more likely to be admitted to long-term care (aHR 1.17, 95% CI: 1.03–1.33), but there was no significant difference in recurrent stroke.

Nearly half of EVT patients underwent inter-hospital transfer, which showed a time-varying association with all-cause mortality, with early risk that attenuated after 6.3 months and reversed over time.

A better understanding of calcitonin gene-related peptide (CGRP) inhibitor use is in migraine treatment needed.

A retrospective, observational, population-based cohort study was conducted using administrative data. Adults (≥18 years) who received ≥1 prophylactic CGRP inhibitor in Canada (six provinces) between 2018 (first approved) and 2023 were identified. CGRP inhibitor use was described; migraine-related acute medication and healthcare use were compared pre–post CGRP inhibitor initiation (independent and paired t-tests).

12,851 adults were identified. CGRP inhibitor use increased from 11.8 (incident/prevalent) to 22.4 (incident) and 57.3 (prevalent) per 100,000 adults. Erenumab use decreased over time, as use of newer agents increased. During the 1-year period after CGRP inhibitor initiation, 57.4% had concomitant use with a different prophylactic migraine medication class (onabotulinumtoxinA injection: 23.2%; oral non-CGRP inhibitor: 34.2%), and 30.4% stopped use (21.3% switched to a different prophylactic migraine medication class; 9.1% discontinued all prophylactic migraine medication). During the 1-year period after CGRP inhibitor initiation (versus before), days of supply for migraine-related acute medication was lower (mean [standard deviation]: 129 [191] versus 145 [197] days; mean difference [95% confidence interval]: −16: [−22, −11] days), as were the number of healthcare visits (7.36 [8.70] versus 9.18 [10.10]; −1.82 [−2.06, −1.58]).

CGRP inhibitor use increased from 2018 to 2023. After CGRP inhibitor initiation, most patients had concomitant use with a different prophylactic migraine medication class, and some stopped use; migraine-related acute medication and healthcare use were lower (versus before). Findings provide a real-world description of the evolving landscape of CGRP inhibitor use in Canada.

This study aimed to evaluate the quality of information provided by artificial intelligence (AI) applications regarding ENT surgeries and usability for patients.

ChatGPT 4.0, GEMINI 1.5 Flash, Copilot, Claude 3.5 Sonnet and DeepSeek-R1 were asked to provide detailed responses to patient-oriented questions about 15 ENT surgeries. Each AI application was queried three times, with a 3-day interval between each session. Two ENT specialists evaluated all responses using the Quality Analysis of Medical Artificial Intelligence (QAMAI) tool.

Average QAMAI scores for each AI application were as follows: ChatGPT 4.0 (27.56 ± 1.20), GEMINI 1.5 Flash (26.24 ± 1.26), Copilot (26.84 ± 1.35), Claude 3.5 Sonnet (28.24 ± 0.77) and DeepSeek-R1 (28.13 ± 0.84). A statistically significant difference was found among the applications (p < 0.001). ICC analysis indicated high stability across evaluations conducted for all five AI applications (p < 0.001).

AI has the potential to provide patients with accurate and consistent information about ENT surgeries, yet differences in QAMAI scores show that information quality varies between platforms.

Movement disorders (Parkinson’s disease, essential tremor, dystonia) are debilitating, progressive conditions that profoundly impact patients’ quality of life. Surgical therapies, such as deep brain stimulation (DBS) can provide tremendous relief to patients but remain costly and, therefore, limited in availability. It is critical to understand regional barriers to accessing this service to improve access for all patients who may benefit from it.

This is a mixed methods survey of stakeholders (patients/family members, advocacy groups, family physicians, neurologists, neurosurgeons) assessing perceived barriers to DBS for movement disorders. Closed and open-ended questions were used. Descriptive statistics were used to highlight regions of Canada where perceived access is poor and to identify barriers to access.

A total of 220 responses were recorded (12 neurosurgeons, 22 neurologists, 30 family physicians, 153 patients and caregivers and 3 advocacy group personnel). Themes included limited resources/centralization of resources, education, burdensome referral patterns and personal patient factors. Barriers included costs associated with travel, waitlists, lack of specific resources and poor understanding of movement disorders, DBS indications and referral pathways.

A number of barriers to access to DBS have been identified, related to geography and centralization of services, referrals and need for further education of indications and safety. The use of virtual care, centralized referral pathways and further research to determine the true prevalence of candidates for this therapy are required to improve access to DBS for movement disorders in Canada.

During the COVID-19 pandemic, virtual physician visits rapidly increased among community-dwelling older persons living with dementia (PLWD) in Ontario. Rural residents often have less access to medical care compared to their urban counterparts, and it is unclear whether access to virtual care was equitable between PLWD in urban versus rural locations.

Using population-based health administrative data and a repeated cross-sectional study design, we identified and described community-dwelling PLWD between March 2020 and August 2022 in Ontario, Canada. Poisson regression was used to calculate rate ratios (RR) and 95% confidence intervals comparing rates of virtual visits between rural and urban PLWD by key physician specialties: family physicians, neurologists and psychiatrists/geriatricians.

Of 122,751 PLWD in our cohort, 9.2% (n = 11,304) resided in rural areas. Rural PLWD were slightly younger compared to their urban counterparts (mean age = 81 vs. 82 years; standardized difference = 0.16). There were no differences across areas by sex or income quintile. In adjusted models, rates of virtual visits were significantly lower for rural compared to urban PLWD across all specialties: family physicians (RR = 0.71 [0.69–0.73]), neurologists (RR = 0.79 [0.75–0.83]) and psychiatrists/geriatricians (RR = 0.72 [0.68–0.76]).

PLWD in rural areas had significantly lower rates of virtual family physician, neurologist and psychiatrist/geriatrician visits compared to urban dwellers during the study period. This finding raises important issues regarding access to primary and specialist healthcare services for rural PLWD. Future work should explore barriers to care to improve health care access among PLWD in rural communities.

Childhood maltreatment (CM) significantly increases the risk of developing post-traumatic stress disorder (PTSD) for which the prevalence in Europe is higher than initially assumed. While the high economic burden of PTSD is well-documented, little is known about the health care cost differences between individuals with PTSD-CM and those without PTSD in Germany. This study aimed to determine the excess health care and absenteeism costs associated with PTSD-CM in Germany.

Baseline data from a multi-center randomized controlled trial on individuals with PTSD-CM (n = 361) were combined with data from individuals without PTSD (n = 4760). Entropy balancing was used to balance the data sets with regard to sociodemographic characteristics. Six-month excess health care costs from a societal perspective were calculated for 2022, using two-part models with logit specification for the first part and a generalized linear model for the second part.

The total six-month excess costs associated with PTSD-CM were €8864 (95% CI: €6855 to €10,873) per person. Of this, the excess health care costs accounted for €4647 (95% CI €3296 to €5997) and the excess costs of absenteeism for €4217 (95% CI: €3121 to €5314). Individuals with mild to moderate PTSD symptoms incurred total excess costs of €6038 (95% CI: €3879 to €8197), while those with severe to extreme symptoms faced €11,433 (95% CI: €8220 to €14,646).

Excess health care and absenteeism costs associated with PTSD-CM were substantial, with absenteeism accounting for roughly half of the total excess costs.

Dissemination and implementation (D&I) scientists are key members of collaborative, interdisciplinary clinical and translational research teams. Yet, early career D&I researchers (ECRs) have few guidelines for cultivating productive research collaborations. We developed recommendations for ECRs in D&I when serving as collaborators or co-investigators.

We employed a consensus-building approach: (1) group discussions to identify 3 areas of interest: “Marketing yourself” (describing your value to non-D&I collaborators), “Collaboration considerations” (contributions during proposal development), and “Responsibilities following project initiation” (defining your role throughout projects); (2) first survey and focus groups to iteratively rank/refine sub-domains within each area; (3) second survey and expert input on clarity/content of sub-domains; and (4) iterative development of key recommendations.

Forty-four D&I researchers completed the first survey, 12 of whom attended one of three focus groups. Twenty-nine D&I researchers completed the second survey (n = 29) and 10 experts provided input. We identified 25 recommendations. Findings suggest unique collaboration strengths (e.g, partnership-building) and challenges (e.g., unclear link to career milestones) for ECR D&I researchers, and underscore the value of ongoing training and mentorship for ECRs and the need to intersect collaborative D&I efforts with health equity principles.

Research collaborations are essential in clinical and translational research. We identified recommendations for D&I ECRs to be productive research collaborators, including training and support needs for the field. Findings suggest an opportunity to examine research collaboration needs among early career D&I scientists, and provide guidance on how to successfully provide mentorship and integrate health equity principles into collaborative research.

Antipsychotic-induced weight gain (AIWG) is a substantial contributor to high obesity rates in psychiatry. Limited management guidance exists to inform clinical practice, and individuals with experience of managing AIWG have had no or minimal input into its development. A lack of empirical research outlining patient values and preferences for management also exists. Recommendations addressing weight management in psychiatry may be distinctly susceptible to ideology and sociocultural values regarding intervention appropriateness and expectations of self-management, reinforcing the need for co-produced management guidance. This study is the first to ask: how do individuals conceptualise preferred AIWG management and how can this be realised in practice?

1. Explore the management experiences of individuals with unwanted AIWG. 2. Elicit their values and preferences regarding preferred management.

Qualitative descriptive methodology informed study design. A total of 17 participants took part in semi-structured interviews. Data analysis was undertaken using reflexive thematic analysis.

Participants reported that clinicians largely overestimated AIWG manageability using dietary and lifestyle changes. They also reported difficulties accessing alternative management interventions, including a change in antipsychotic and/or pharmacological adjuncts. Participants reported current management guidance is oversimplified, lacks the specificity and scope required, and endorses a ‘one-size-fits-all’ management approach to an extensively heterogenous side-effect. Participants expressed a preference for collaborative AIWG management and guidance that prioritises early intervention using the range of evidence-based management interventions, tailored according to AIWG risk, participant ability and participant preference.

Integration of this research into guideline development will help ensure recommendations are relevant and applicable, and that individual preferences are represented.

Operative cancellations adversely affect patient health and impose resource strain on the healthcare system. Here, our objective was to describe neurosurgical cancellations at five Canadian academic institutions.

The Canadian Neurosurgery Research Collaborative performed a retrospective cohort study capturing neurosurgical procedure cancellation data at five Canadian academic centres, during the period between January 1, 2014 and December 31, 2018. Demographics, procedure type, reason for cancellation, admission status and case acuity were collected. Cancellation rates were compared on the basis of demographic data, procedural data and between centres.

Overall, 7,734 cancellations were captured across five sites. Mean age of the aggregate cohort was 57.1 ± 17.2 years. The overall procedure cancellation rate was 18.2%. The five-year neurosurgical operative cancellation rate differed between Centre 1 and 2 (Centre 1: 25.9%; Centre 2: 13.0%, p = 0.008). Female patients less frequently experienced procedural cancellation. Elective, outpatient and spine procedures were more often cancelled. Reasons for cancellation included surgeon-related factors (28.2%), cancellation for a higher acuity case (23.9%), patient condition (17.2%), other factors (17.0%), resource availability (7.0%), operating room running late (6.4%) and anaesthesia-related (0.3%). When clustered, the reason for cancellation was patient-related in 17.2%, staffing-related in 28.5% and operational or resource-related in 54.3% of cases.

Neurosurgical operative cancellations were common and most often related to operational or resource-related factors. Elective, outpatient and spine procedures were more often cancelled. These findings highlight areas for optimizing efficiency and targeted quality improvement initiatives.

Limited evidence exists regarding care pathways for stroke survivors who do and do not receive poststroke spasticity (PSS) treatment.

Administrative data was used to identify adults who experienced a stroke and sought acute care between 2012 and 2017 in Alberta, Canada. Pathways of stroke care within the health care system were determined among those who initiated PSS treatment (PSS treatment group: outpatient pharmacy dispensation of an anti-spastic medication, focal chemo-denervation injection, or a spasticity tertiary clinic visit) and those who did not (non-PSS treatment group). Time from the stroke event until spasticity treatment initiation, and setting where treatment was initiated were reported. Descriptive statistics were performed.

Health care settings within the pathways of stroke care that the PSS (n = 1,079) and non-PSS (n = 22,922) treatment groups encountered were the emergency department (86 and 84%), acute inpatient care (80 and 69%), inpatient rehabilitation (40 and 12%), and long-term care (19 and 13%), respectively. PSS treatment was initiated a median of 291 (interquartile range 625) days after the stroke event, and most often in the community when patients were residing at home (45%), followed by “other” settings (22%), inpatient rehabilitation (18%), long-term care (11%), and acute inpatient care (4%).

To our knowledge, this is the first population based cohort study describing pathways of care among adults with stroke who subsequently did or did not initiate spasticity treatment. Areas for improvement in care may include strategies for earlier identification and treatment of PSS.

Alzheimer’s disease (AD) is experienced by > 600,000 Canadians. Disease-modifying therapies (DMTs) for earlier stages of disease are in development. Existing health system capacity constraints and the need for biomarker-driven diagnostics to confirm DMT eligibility are concerning. This study aimed to characterize the capacity gap related to early AD (eAD) treatment with DMTs in Canada.

A capacity model was developed to simulate the flow of a patient from screening to treatment for eAD to quantify the gap between available and required healthcare resources and qualify the bottlenecks restricting the patient journey at a provincial and national level. The model inputs (epidemiological, human resource, and clinical) were evidence-based, healthcare professional-, and patient advocate-informed.

The model estimated that nationally < 2% of patients would have access to the required healthcare resources for treatment with a DMT. Eligibility assessment represented the step with the largest capacity gap across all provinces, with a wait list of about 382,000 Canadians one year following DMT introduction. The top three resource gaps included AD specialist time and positron emission tomography and magnetic resonance imaging exam slots. Sensitivity analysis showed that full reliance on cerebrospinal fluid for eligibility testing increased capacity for assessment by about 47,000 patients.

This model highlights that the Canadian health system is critically under-resourced to diagnose, assess, and treat patients with eAD with DMT. It underscores an urgent need for national policy and provincial resource allocation to close the gap.

Patients with hearing loss and tinnitus face lengthy waits to be seen in the ENT clinic. SHOEBOX Audiometry is an iPad-based, audiometric screening tool. A virtual hearing loss and non-pulsatile tinnitus clinic involving an ENT specialist virtually assessing cases based on the SHOEBOX audiogram, a patient symptom questionnaire and the primary care referral letter were implemented. This service evaluation explored the outcomes of the virtual clinic in reducing the need for a face-to-face ENT appointment.

This was a retrospective service evaluation of the first six months of the virtual hearing loss and non-pulsatile tinnitus clinic.

A total of 210 patients were included: 34.8 per cent (73) were discharged without requiring audiologist assessment or an ENT appointment, 51.9 per cent (109) required formal audiological assessment, 36.7 per cent (77) required imaging and only 13.8 per cent (29) required a face-to-face ENT appointment.

A virtual hearing loss and non-pulsatile tinnitus clinic minimised the number of patients requiring a traditional face-to-face clinic appointment within ENT.

A national electronic health record is being procured for Health Service Executive hospitals in Ireland. A number of hospitals have implemented an electronic document management system. This study aimed to investigate the efficiency and safety of the electronic document management system in our centre.

A retrospective audit was performed of patients operated on at Galway University Hospital. The availability and location of patients’ admission data on the electronic document management system were recorded. These data were analysed using Microsoft Excel software, version 16.45.

The records of 100 patients were analysed. The main findings were: 5 per cent of operation notes were missing, 80 per cent were in the incorrect section, while 15 per cent were in the correct ‘procedure’ section on the electronic document management system.

This study shows there is potential for error with ‘paper-light’ solutions, whereby delayed scanning, misfiling of scanned records and missing records may lead to significant delays in treatment and potential patient safety issues.