Benefits of the PRISM Shelter-Based Program for Attainment of Stable Housing and Functional Outcomes by People Experiencing Homelessness and Mental Illness: A Quantitative Analysis.

OBJECTIVE: To explore the housing trajectory, personal recovery, functional level, and quality of life of clients at discharge and 1 year after completing Projet Réaffiliation Itinérance Santé Mentale (PRISM), a shelter-based mental health and rehabilitation program intended to provide individuals experiencing homelessness and severe mental illness with transition housing and to reconnect them with mental health and social services. METHOD: Housing status, psychiatric follow-up trajectory, personal recovery (Canadian Personal Recovery Outcome Measure), functional level (Multnomah Community Ability Scale), and quality of life (Lehman Quality of Life Interview) were assessed at program entry, at program discharge and 1 year later. RESULTS: Of the 50 clients who participated in the study from May 31, 2018, to December 31, 2019, 43 completed the program. Of these, 76.7% were discharged to housing modalities and 78% were engaged with psychiatric follow-up at the program's end. Housing stability, defined as residing at the same permanent address since discharge, was achieved for 62.5% of participants at 1-year follow-up. Functional level and quality of life scores improved significantly both at discharge and at 1-year follow-up from baseline. CONCLUSIONS: Admission to PRISM helped clients secure long-term stable housing and appropriate psychiatric follow-up. Stable housing was maintained for most clients at 1-year follow-up, and they benefited from sustained functional and quality of life outcomes in long-term follow-up.

Report from the Ready for the Next Round Thought-Leadership Roundtables on Building Resilience in Cancer Care and Control in Canada-Colorectal Cancer Canada; 2021.

(1) Background: The COVID-19 pandemic illuminated vulnerabilities in the Canadian health care system and exposed gaps and challenges across the cancer care continuum. Canada is experiencing significant disruptions to cancer-related services, and the impact these disruptions (delays/deferrals/cancellations) have on the health care system and patients are yet to be determined. Given the potential adverse ramifications, how can Canada's health care systems build resilience for future threats? (2) Methods: To answer this question, CCC facilitated a series of four thought-leadership roundtables, each representing the views of four different stakeholder groups: patients, physicians, health care system leaders, and researchers. (3) Results: Six themes of strength were identified to serve as a springboard for building resilience including, (1) advancing virtual care and digital health technologies to prevent future interruptions in cancer care delivery. (2) developing real-time data metrics, data sharing, and evidence-based decision-making. (3) enhancing public-private-non-profit partnerships to advance research and strengthen connections across the system. (4) advancing patient-centricity in cancer research to drive and encourage precision medicine approaches to care. (5) investing in training and hiring a robust supply of health care human resources. (6) implementing a national strategy and infrastructure to ensure inter-provincial collaborative data sharing (4). Conclusions: A resilient health care system that can respond to shocks and threats is not an emergency system; it is a robust everyday system that can respond to emergencies.

Is isolated bladder outlet obstruction associated with hydronephrosis? A database analysis.

AIMS: To examine whether isolated bladder outlet obstruction in the absence of associated lower urinary tract abnormality results in hydronephrosis. Isolated obstruction causes a brief rise in bladder pressure that might not trigger hydronephrosis. METHODS: Data included adult men who underwent urodynamics for refractory non-neurogenic lower tract symptoms between 2011 and 2020. International Continence Society indices for obstruction (bladder outlet obstruction index [BOOI] ≥ 40) and underactivity (bladder contractility index [BCI] < 100) were calculated. Storage abnormality was defined as detrusor overactivity (DO) or poor compliance (<20 ml/cm H2 0). Isolated obstruction was defined as BOOI ≥ 40, BCI ≥ 100 and no storage abnormality. Nonparametric tests using R program (3.5.0) applied (p < .05 significant). Logistic regression analyses were performed to study the relationships of hydronephrosis with lower urinary tract function. RESULTS: A total 1596 men (range, 18-91 years; median, 51.0 years; Q3, 64.0 years; Q1, 34.0 years) were eligible. Hydronephrosis was noted in 274 (17.2%). A total of 45.4% were obstructed, 52.3% were underactive and 41.7% had storage abnormality. Storage abnormality (odds ratios [OR], 2.05; 95% confidence interval [CI]: 1.56, 2.69; p < .001) and bladder contractility (OR, 1.68; 95% CI, 1.25-2.26; p < .001) but not obstruction (OR, 1.07; 95% CI, 0.80-1.44; p = .634) was associated with hydronephrosis. Of eight possible combinations, men with BOO ≥ 40, BCI ≥ 100 and storage abnormality had highest probability of hydronephrosis (OR, 0.29; 95% CI, 0.24-0.33). Subanalysis showed that poor compliance (OR, 3.39; 95% CI, 2.49-4.60; p < .001) but not DO was associated with hydronephrosis. Younger age and higher postvoid residual urine were also associated with hydronephrosis. CONCLUSIONS: In adult men with refractory non-neurogenic lower urinary tract symptoms, isolated bladder outlet obstruction is not associated with hydronephrosis.