St. Michael's Hospital

Patient-identified barriers and facilitators to maternal health care in lmics: a qualitative study in Argentina and Ethiopia

Abstract Background Ninety-nine percent of global maternity deaths occur in low-and-middle-income countries (LMICs), despite availability of high quality evidence-based guidelines for common causes of maternal mortality. An understanding of barriers and facilitators (BFs) to acce...

Systematic review of clinical trials and cohort studies evaluating HIV post‐exposure prophylaxis (PEP) regimens to inform updated Canadian guidelines

Abstract Background We conducted a systematic review of clinical trials and cohort studies on HIV post‐exposure prophylaxis (PEP) regimens to inform updated 2025 Canadian guidelines. Methods We searched Medline and Embase (July 2017–June 2024) for studies reporting on: HIV acquis...

Laryngeal Manifestations of Rheumatic Disease

Rheumatologic diseases are systemic, immune-mediated disorders that frequently involve the larynx, producing manifestations that range from subtle dysphonia to life-threatening airway obstruction. Laryngeal involvement may precede systemic disease, progress despite adequate syste...

Expired endoscopic devices remain sterile and functional: an international multicentre study challenging current shelf-life criteria

Background and study aims Expired medical devices represent an environmental and economic concern, yet their magnitude and true shelf life remain poorly defined. We aimed to quantify the volume and cost of expired endoscopic devices and evaluate their sterility and functionality...

Intravascular Lithotripsy in Left Main Stem Percutaneous Coronary Intervention

ABSTRACT Background IVL is increasingly used for coronary calcium modification; however, prospective data for its use in LMS lesions are lacking. Aims To evaluate the feasibility, safety, and mechanical efficacy of intravascular lithotripsy (IVL) for calcium modification in calci...

Exclusive and Any Breastfeeding, Infant Formula Feeding, and Childhood Growth

OBJECTIVES: To understand the association between exclusive breastfeeding, any breastfeeding, and infant formula feeding and childhood growth. METHODS: A longitudinal cohort study was conducted among children from birth up to 10 years in Toronto, Canada. The primary exposure was...

Reconsidering the Alberta study of the closure of the Red Deer supervised consumption site

Supervised consumption sites (SCS) are interventions supported by decades of evidence and yet remain subject to considerable politicization. Recently, researchers from Alberta, Canada published a study in the journal Addiction that sought to assess the impacts of the closure of a...

Ultrasound-Activated Microbubbles for Precision Chemo-Radioenhancement in Prostate Cancer: Sonoporation, Therapeutic Synergy, and Translational Pathways

Background/Objectives: Radiotherapy and docetaxel are mainstays of prostate cancer management, yet both are constrained-radiotherapy by normal-tissue tolerance and docetaxel by systemic toxicity and acquired resistance. Ultrasound-activated microbubbles (USMB) convert acoustic en...

Trends in opioid containing drug seizures described as pills between 2020 and 2024 in Canada

People who use drugs may access prescription opioids from unregulated markets to avoid fentanyl and lower toxicity risk, though concerns regarding counterfeit pills have emerged. To better understand the composition of pills that may be circulating in the unregulated drug supply,...

Treatment outcomes after initiating buprenorphine/naloxone or methadone for opioid use disorder among First Nation Peoples in Ontario, Canada

Background The Canadian opioid toxicity crisis has disproportionately harmed First Nation Peoples. We compared opioid agonist treatment (OAT) outcomes within this population. Methods Our population-based cohort included First Nation Peoples in Ontario, Canada, who initiated bupre...

Contribution of Adolescent Movement Behaviours to Socioeconomic Inequalities in Adult Cardiovascular Disease Risk: A Causal Decomposition in a Population-Based Cohort

Abstract Addressing unhealthy movement behaviours in adolescence could reduce socioeconomic inequalities in adult cardiovascular disease (CVD) risk. Among 6608 adolescents enrolled in the Add Health cohort (1994-1995) and followed into adulthood (2016-2018), movement behaviours (...

Association between Glycemic Control and Survival in Patients with Type 2 Diabetes on Peritoneal Dialysis

Background: Diabetes is the leading cause of kidney failure globally affecting 40% of people receiving peritoneal dialysis (PD). High quality data on the potential impact of improving glycemic control is needed to inform the current recommendations to individualise HbA 1C targets...

Using evidence briefs to support future implementation planning: the case of early fibrinolysis for myocardial infarction and rehabilitation for the amputee patient in Colombia

Abstract Background Despite the relevance of clinical practice guidelines for health policy development, planning, evaluation and quality improvement, implementation of the Colombian national guidelines is still in early stages. The objective of this study was to develop two evid...

Implementation and evaluation of a technical support center for the Research to Enhance the Adaptation and Implementation of Health Systems Guidelines in LMICs [RAISE] initiative

Abstract Background Capacity-strengthening initiatives for health policy and systems research (HPSR) in low- and middle- income countries (LMICs) are often designed with little consideration of LMIC stakeholder needs. We formed a Technical Support Centre to support research teams...

Adapting and implementing health systems guidelines: learning lessons from countries

Adapting and implementing evidence-based health system guidelines presents numerous challenges, particularly when they are introduced in settings that differ from those in which they were originally developed [ 1 ]. Effective implementation requires careful consideration of local...

Adaptation and pilot implementation of the WHO guideline on digital intervention to strengthen mental health systems in Lagos state, Nigeria

Abstract Background The uptake and implementation of cost-effective interventions and programs for mental health problems are often threatened by weakened health systems (HS) in low- and middle-income countries (LMICs). Digital technologies provide concrete opportunities to tackl...

Developing a strategy for identifying recommendations prioritized for implementation in the Colombian health system

Abstract Background Health systems guidelines (HSGs) developed by the WHO and clinical practice guidelines (CPGs) developed by the Colombian Ministry of Health can potentially support national and subnational policy-development processes. Barriers to implementation encountered wh...

One of the Best Parts – Workplace Walk-Throughs: Findings from a 2025 Canadian Survey of Physicians Practicing in Occupational Medicine

Objective: Workplace walk-throughs (WWs) are a sine qua non for gaining experience on how workplace hazards affect health. This study examines physicians’ experiences participating in WWs. Methods: This cross-sectional study examined responses from a module on WWs in a 2025 onlin...

Quantitative assessment of national essential medicines lists processes: a descriptive study of 143 countries

The National Essential Medicines List (NEML) selection process is a foundational component of an essential medicines based policy, and the NEML itself is a key policy tool. The World Health Organization (WHO) provides guidance for policy development that aligns with the Accountab...

Extracorporeal CO2 elimination for acute exacerbation of severe COPD requiring invasive mechanical ventilation: a randomized controlled trial (the X-COPD trial)

Abstract Rationale Acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) requiring invasive mechanical ventilation (IMV) are associated with high mortality and long-term disability. Extracorporeal CO₂ removal (ECCO₂R) using modern high-capacity devices may facili...