The Canadian Cancer Research Conference 2019.

The 5th Canadian Cancer Research Conference (ccrc) took place 3-5 November 2019 in Ottawa, Ontario. Nearly 1000 participants-scientists, oncologists, community members, and patients-gathered to share knowledge, foster collaboration, and fuel the future of cancer research in Canada. The scientific program included 3 plenary sessions, 26 concurrent sessions, and 2 poster sessions presenting research described in more than 600 submitted abstracts, giving participants the opportunity to share health research that collectively encompassed the 4 pillars recognized by the Canadian Institutes of Health Research. In addition to the breadth of topics addressed by Canadian and international experts, the highlights of the meeting included the integration of patients and patient advocates, new rapid-fire sessions for abstract presentation, and events that enhanced learning opportunities for trainees.

Postmortem sperm procurement.

PURPOSE: We determined the prevalence of requests for postmortem sperm procurement and the degree to which procurement is performed by those working in the field of infertility. MATERIALS AND METHODS: Structured telephone interviews were conducted with personnel at 273 assisted reproductive facilities in the United States and Canada. The number of facilities reporting requests and the number of facilities reporting that they performed the procedure were determined. RESULTS: The prevalence of requests for postmortem sperm procurement was much greater than initially anticipated. A total of 82 requests was reported at 40 facilities in 22 different states between 1980 and 1995. More than half of the reported requests (43) were made between 1994 and 1995. Of the 82 requests 25 were honored at 14 facilities in 11 different states. No requests or procedures were reported from Canada. CONCLUSIONS: Medical advances in postmortem sperm procurement, cryopreservation and in vitro fertilization permit retrieval of sperm after death for various purposes, including posthumous fatherhood. There are no explicit ethical guidelines, legislation or relevant case law, and fertility specialists must confront these issues before proceeding in a field fraught with moral and policy uncertainties.

Hospital policies on life-sustaining treatments and advance directives in Canada.

OBJECTIVE: To determine the prevalence and content of hospital policies on life-sustaining treatments (cardiopulmonary resuscitation [CPR], mechanical ventilation, dialysis, artificial nutrition and hydration, and antibiotic therapy for life-threatening infections) and advance directives in Canada. DESIGN: Cross-sectional mailed survey. SETTING: Canada. PARTICIPANTS: Chief executive officers or their designates at public general hospitals. MAIN OUTCOME MEASURES: Information regarding the existence of policies on life-sustaining treatments or advance directives and the content of the policies. RESULTS: Questionnaires were completed for 697 (79.2%) of the 880 hospitals surveyed. Of the 697 respondents 362 (51.9%) sent 388 policies; 355 (50.9%) sent do-not-resuscitate (DNR) policies (i.e., policies that addressed CPR alone or in combination with other life-sustaining treatments). Of the 388 policies 327 (84.3%) addressed CPR alone, 28 (7.2%) addressed CPR plus other life-sustaining treatments, 10 (2.6%) addressed advance directives, and the remaining 23 (5.9%) addressed other life-sustaining treatments. Of the 355 DNR policies 1 (0.3%) stated that routine discussion with patients is required, 315 (88.7%) restricted their scope to terminally or hopelessly ill patients, 187 (52.7%) mentioned futility, 29 (8.2%) mentioned conflict resolution, 9 (2.5%) and 13 (3.7%) required explicit communication of the decision to the competent patient or family of the incompetent patient respectively, 110 (31.0%) authorized the family of an incompetent patient to rescind the DNR order, 224 (63.1%) authorized the nursing staff to do so, and 217 (61.1%) authorized physicians to do so. CONCLUSIONS: Although about half of the public general hospitals surveyed had DNR policies few had policies regarding other life-sustaining treatments or advance directives. Existing policies could be improved if hospitals encouraged routine advance discussions, removed the restriction to terminally or hopelessly ill patients, scrutinized the use of the futility standard, stipulated procedures for conflict resolution, explicitly required communication of the decision to competent patients or substitute decision-makers of incompetent patients and scrutinized the provision allowing families and health care professionals to rescind the wishes of now incompetent patients.

Patients with rheumatoid arthritis are more tender than those with psoriatic arthritis.

Articular and nonarticular tenderness was examined in 51 patients with rheumatoid arthritis (RA) and 50 patients with psoriatic arthritis (PsA) by scored palpation and dolorimeter readings. Fifty-seven percent of patients with RA had 10 or more tender fibrositic points vs 24% of patients with PsA (p = 0.0008). Thresholds of tenderness measured by dolorimetry of 6 fibrositic point sites were 3.97 (1.99) [mean (SD)] for RA vs 5.95 (2.28) for PsA (p less than 0.0001). Thresholds over actively inflamed joints were 4.19 (1.53) for RA vs 6.78 (2.55) for PsA (p less than 0.0001). In both RA and PsA, fibrositic sites were more tender than actively inflamed joints (p less than 0.0001). Nonarticular control sites were also more tender in subjects with RA with dolorimeter thresholds at 5.99 (1.96) in RA vs 7.58 (1.60) in PsA (p less than 0.0001). These data demonstrate that actively inflamed joints, fibrositic and control nonarticular sites were all more tender in patients with RA than PsA. Both groups were similar in their disease duration and clinical assessments of joint inflammation and damage. We suggest that there may be a disease specific diffuse increase in tenderness in patients with RA, which is not related to joint inflammation. Similarly, the severity of articular inflammation may be underestimated in subjects with PsA.

Control and "fibrositic" tenderness: comparison of two dolorimeters.

It can be as important to quantify lack of tenderness, as tenderness. Palpation detects tenderness only; dolorimeters with a limited scale restrict ability to assess variations in thresholds at clinically nontender sites. Such variations must be measured if we are to evaluate generally acting factors affecting tenderness. We measured thresholds at "fibrositic" and control sites in 8 subjects, using 2 observers and 2 different dolorimeters. The traditional Chatillon dolorimeter yielded twice as many readings off the 9 kg scale (17 of 96 versus 8 of 96) as the Fischer instrument, with a scale of 11 kg [continuity corrected (chi 2 = 3.725, p = 0.086)/bd. The Fischer instrument also used a footplate with a smaller diameter, and results using the 2 instruments were not parallel. Median values were the same (5.1 kg), but the Fischer instrument gave lower readings at tender sites (10th percentile 2.4 versus 2.9 kg) and higher values at nontender sites. Thresholds at fibrositic and control sites were significantly correlated, reinforcing evidence of generally acting factors affecting tenderness.

Fibromyalgia in human immunodeficiency virus infection.

Tenderness was assessed by point count and by scored palpation in 51 patients with human immunodeficiency virus (HIV) infection as well as 51 patients with rheumatoid arthritis (RA) and 50 patients with psoriatic arthritis (PsA). Fifteen of 51 (29%) patients with HIV infection met criteria for fibromyalgia, based on the presence of 10 tender (of 14) "fibrositic" points. Similar results were observed among patients with PsA (24%). The prevalence of fibromyalgia was higher among patients with RA (57%). Patients with HIV and PsA were less tender than patients with RA. Fibromyalgia in patients with HIV was significantly associated with myalgia and arthralgia, but not with age, duration of HIV infection, stage of HIV disease, or zidovudine therapy.