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Rates of morbidity and mortality are significantly higher in homeless populations. Homeless people experience many barriers to receive adequate palliative care. This qualitative study examines how a major urban city's palliative care resources can be improved to increase access and better serve the homeless. Audiotaped interviews were preformed with 7 homeless care providers in Toronto, Canada, and their transcripts were analyzed using thematic analysis. The findings of the study suggest that in order to increase access and to serve the city's terminally ill homeless better, the following 4 areas must be addressed: (1) increasing positive interaction between the health care system and the homeless, (2) training staff to deal with the unique issues confronting the homeless, (3) providing patient-centered care, and (4) diversifying the methods of delivery.

The low prostate cancer mortality in our surveillance cohort provides support for an active surveillance approach to favorable risk prostate cancer. Only 1 of the 5 patients presented with favorable disease and experienced a theoretically preventable death. The absence of preventable deaths suggests that the basic approach is sound. Two patients had a trigger for intervention but did not receive it. This reinforces the importance of close monitoring and of definitive treatment for those in whom disease is reclassified as higher risk over time.

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Background There is much controversy regarding the appropriate evaluation and management of testosterone deficiency (TD). Aim To compare current guidelines on the evaluation and management of TD to provide clarity for patients and clinicians, as well as to highlight areas of controversy. Methods A literature search of MEDLINE, Embase, Cochrane Library, and various association websites was performed to identify guidelines for TD. Outcomes Key aspects in the approach were compared, with a focus on the biochemical definition (cutoff) for low testosterone (T), principles of management, and recommendations for testosterone therapy (TTh) in special patient populations. Results Guidelines from the Canadian Medical Association Journal, American Urological Association, European Association of Urology, Endocrine Society, International Society for Sexual Medicine, and British Society for Sexual Medicine were included for review. Recommendations were generally consistent across guidelines. Key differences include the biochemical cutoff for low T, and recommendations for patients with low to normal T, prostate cancer, or cardiovascular disease. We highlight several case scenarios in which management differs depending on the guideline adopted. Clinical Implications Although general diagnostic and management principles are in agreement across the guidelines, notable differences may impact patient diagnosis and eligibility for TTh. Strengths & Limitations Only guidelines written in English were included. The quality of the included guidelines was not evaluated, but this was beyond the scope of this review. Conclusion We highlight the limitations of relying exclusively on guidelines in managing patients with TD.

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Introduction: Female sexual dysfunction (FSD) is characterized as distress related to sexual pain, sexual arousal, sexual desire, and/or orgasmic dysfunction. Despite prevalence rates similar to male sexual dysfunction, women with sexual complaints have been long under-evaluated, treated, and studied. Over the last decade there have been advances in the medical evaluation and management of FSD, however, there remains a paucity of clinical resources available for women in Canada with sexual dysfunction. Methods: The state of knowledge in the evaluation and treatment of FSD was reviewed. Recommendations are given for the practical evaluation and treatment of women with sexual symptoms that can be applied widely in Canada. Results: Approaches to the management and treatment of FSD are discussed with a focus on the practical application of diagnostic and therapeutic tools in the management of sexual pain, low desire, low arousal, and orgasmic dysfunction. Conclusions: There are evidence-based diagnostic and therapeutic approaches to FSD that can be broadly applied by Canadian physicians to improve access to female sexual medicine in Canada.