Despite extensive research, age, family history, race and ethnicity, and certain genetic sequence variants remain the only currently well-established risk factors for prostate cancer. Black men are purported to have an increased risk of early and aggressive prostate cancer. This higher risk classification for Black men has resulted in recommendations for earlier prostate cancer screening and evidence of distinctive treatment patterns. 1,2 However, the underlying data for these recommendations lack high-quality evidence, rendering the validity of these conclusions uncertain.Data from the Canadian health care system are well suited for studying the association of race and ethnicity and prostate cancer mortality, owing to Canada's diverse population and universal health care model. MethodsThis cohort study was approved by the Western University Institutional Research Ethics Board.Statistics Canada datasets were used for the research; these datasets incorporate implied consent from Canadian citizens and are subject to stringent reporting and confidentiality guidelines in accordance with the Statistics Act. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.Data from the Statistics Canada Canadian Census Health and Environment Cohorts were used. 3 The mandatory 1991 long-form census (administered to 20% of households) was linked with Canadian health care, tax, and mortality databases (including the Canadian Vital Statistics Death Database, the Canadian Cancer Registry, and the historical postal code file from tax records) to investigate the association of race and ethnicity with prostate cancer mortality in Canada. Individuals who completed the census chose from existing options to categorize their race and ethnicity, with an optional write-in response to describe their ancestry. The categories included in this study were

Immunosuppressive drugs for solid organ transplantation are critical dose drugs with a narrow therapeutic index. Many of the most commonly used innovator drugs are off patent and have been replicated by generic counterparts, often at substantial cost-savings to the patient. However, serious adverse events caused by the transition from innovator to generic medications, specifically in pediatric solid organ transplant recipients, have questioned these autosubstitutions. The purpose of this review is to summarize the criteria set forth by the regulatory bodies, and to examine how major immunosuppressive drugs conform to these recommendations. Regulatory bodies have established inconsistent criteria to demonstrate bioequivalence between innovator and generic medications, causing approved generic variations to have varying levels of equivalence with the innovator drugs. In order to minimize the risk for under-immunosuppression, the following recommendations have been concluded. Brand prescribing of cyclosporine and tacrolimus are recommended due to evidence of adverse events after conversion to generic formulations and differences in dissolution parameters. Mycophenolate mofetil (MMF) shows better bioequivalence between innovator and generic formulations, however caution should be advised when switching between formulations. The institution of 'innovator only' policies may be appropriate at this time in order to minimize the risk of under-immunosuppressing patients until the evidence of more stringent bioequivalence has been established.

The management of an extraperitoneal bladder injury associated with a pelvic fracture Case A 26-year-old female was involved in a motor vehicle accident as a belted driver after losing control at highway speeds and rolling multiple times into a ditch. There was a prolonged extrication and due to inclement weather conditions, the patient was unable to be evacuated by air ambulance. She was transferred by EMS to a peripheral hospital before expedited transfer to a tertiary trauma centre was possible.

Introduction: The Royal College of Physicians and Surgeons of Canada’s Competence by Design (CBD) initiative presents curricula challenges to ensure residents gain proficiency while progressing through training. To prepare first-year urology residents (R1s), we developed, implemented, and evaluated a didactic and simulation-focused boot camp to implement the CBD curriculum. We report our experiences and findings of the first three years. Methods: Urology residents from two Canadian universities participated in the two-day boot camp at the beginning of residency. Eleven didactic and six simulation sessions allowed for instruction and deliberate practice with feedback. Pre-and post-course multiple-choice questionnaires (MCQs) and an objective structured clinical exam (OSCE) evaluated knowledge and skills uptake. For initial program evaluation, three R2s served as historical controls in year 1. Results: Nineteen residents completed boot camp. The mean age was 26.4 (±2.8) and 13 were male. Participants markedly improved on the pre- and post-MCQs (year 1: 62% and 91%; year 2: 55% and 89%; year 3: 58% and 86%, respectively). Participants scored marginally higher than the controls on four of the six OSCE stations. OSCE scores remained >88% over the three cohorts. All participants reported higher confidence levels post-boot camp and felt it was excellent preparation for residency. Conclusions: During its first three years, our urology boot camp has demonstrated high feasibility and utility. Knowledge and technical skills uptake were established via MCQ and OSCE results, with participants’ scores near or above those of R2 controls. This boot camp will remain in our CBD curriculum and can provide a framework for other urology residency programs.

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