Background/Objectives: HbA1c is widely used to identify adults at increased risk of type 2 diabetes mellitus (T2DM), but major guidance differs on whether the lower limit of an HbA1c-defined risk range should be 5.7% (39 mmol/mol) or 6.0% (42 mmol/mol). This systematic review evaluated the prognostic and screening utility of HbA1c 5.7–6.4% compared with HbA1c 6.0–6.4% and examined whether available evidence supports threshold-based allocation of preventive interventions. Methods: The review was reported in accordance with PRISMA 2020 and registered in PROSPERO (CRD42019134344). PubMed/MEDLINE, Embase and the Cochrane Library were searched for studies published from 1 January 2016 to 1 January 2026. Eligible evidence comprised human studies in English, French, Hebrew, Italian or Spanish that evaluated HbA1c ranges below the diabetes diagnostic threshold in adults aged at least 40 years or younger adults with established risk factors. Two reviewers independently screened records and extracted data. Risk of bias was assessed using an adapted QUADAS-2 framework for threshold-performance evidence, supplemented by CASP-informed appraisal, and certainty was rated with GRADE domains. Narrative synthesis was selected because populations, thresholds, comparator tests, follow-up and outcome ascertainment were heterogeneous. Results: Seven studies were included. Evidence consistently supported a graded risk continuum rather than a single biological cut point. HbA1c 5.7–6.4% identifies more adults but includes many at low short-term absolute risk, whereas HbA1c 6.0–6.4%, especially 6.2–6.4% or combined HbA1c and fasting glucose abnormality, identifies fewer adults at higher near-term risk. Direct evidence comparing 5.7% versus 6.0% thresholds came mainly from one UK cohort, with supportive but indirect evidence from meta-analysis, routine-care cohorts and reversion studies. No trial randomized adults to intervention by HbA1c threshold, and eligible evidence did not directly address early diabetes-related morbidity by threshold. Conclusions: HbA1c below the diabetes diagnostic threshold should be interpreted as risk strata, not as a binary disease label. HbA1c 5.7–6.4% is defensible for broad, low-intensity preventive advice, while HbA1c 6.0–6.4% can be used to prioritize structured prevention and closer follow-up. The proposed tiered approach is a pragmatic, hypothesis-generating interpretation of the available evidence rather than a trial-validated intervention algorithm.

Background/Objectives: Western Canadian and U.S. communities outside urban centres remain underserved by primary, specialist, emergency, mental health, and chronic-disease services. These access problems reflect distance, weather, workforce shortages, specialist maldistribution, primary care attachment gaps, broadband limitations, and the governance realities of Indigenous and Tribal communities. This scoping review with narrative synthesis examined how telehealth and virtual-care models affect rural access in western Canada and the western/frontier United States. Methods: Searches were completed on 21 May 2026 in PubMed/MEDLINE, Embase, CINAHL, Scopus, the Cochrane Library, and PubMed Central. Supplementary searches included Google Scholar, publisher platforms, reference-list checking, and official Canadian and U.S. health-system sources. Peer-reviewed evidence published from 1 January 2016 to 21 May 2026 was eligible when it addressed rural, remote, frontier, Indigenous, underserved, western, or northern healthcare settings and reported access, implementation, safety, continuity, equity, or service-use outcomes. Results: The search identified 112 records; 27 duplicates were removed, 85 records were screened, 37 full texts were assessed, and 28 peer-reviewed records were included. Seven official sources were retained separately. Evidence was mainly observational, qualitative, mixed-methods, implementation-focused, or review-level. Moderate confidence supported telehealth for travel reduction and specialist input, especially through eConsultation, provider-to-provider consultation, telementoring, and real-time emergency support. Confidence was low to moderate for hybrid primary care and telemental health, and low for durable reductions in emergency department use. Conclusions: Telehealth may be most appropriately implemented as a hybrid, locally anchored, culturally safe access model, not as a stand-alone substitute for rural primary care, specialist capacity, or emergency services. Implementation should include broadband support, local physical assessment capacity, documentation, continuity, patient education, and clear escalation pathways.

Background: Type II workplace violence by patients, relatives, or visitors is an occupational health and patient-safety concern in primary care. Cranston Ridge Medical Clinic (CRMC), a single urban family medicine and walk-in primary care clinic in Calgary, Alberta, plans to implement a universal, risk-informed workplace-safety bundle that is based on observable behaviour, situational risk, and documented safety concerns rather than demographic profiling. Methods: This article describes a single-site internal quality improvement and workplace-safety evaluation protocol. The comparison is CRMC usual practice during the pre-implementation baseline period; there is no concurrent external control group. The planned evaluation will use aggregate, de-identified operational data from a 12-month pre-implementation baseline, a four-week implementation period, and 12 months of post-implementation monitoring. All clinic staff will receive workplace-safety training as part of routine implementation. No staff, patients, or visitors will be recruited as research participants, and the evaluation will not use individual-level staff survey, interview, or focus-group data. Patient/visitor information will be used only as aggregate operational monitoring data when needed to assess safety, access, patient flow, and complaints. Intervention and analysis: The bundle includes worksite analysis, staff training, a brief arrival safety screen, a response algorithm, standardized reporting, monthly safety huddles, and post-incident support. The primary metric will be the Type II workplace-violence incident rate per 1000 clinic visits. Planned analyses include run charts, pre–post rate ratios, and Poisson or negative binomial segmented regression if monthly counts are sufficient. Implementation learning will be summarized from routine training records, safety-huddle summaries, post-incident debrief themes, and other aggregate de-identified operational indicators. Expected contribution: The protocol contributes a transparent, equity-sensitive, and operationally feasible model for balancing staff safety with patient access in primary care.

Background/Objectives: Patient- and family-initiated abuse of nurses is widely recognized as workplace violence, but it also raises a distinct professional-regulatory question: when may a nurse end or restrict an established therapeutic relationship without creating an allegation of abandonment or discriminatory denial of care? This perspective focuses on Alberta and examines whether the province’s nursing regulator provides a comprehensive, nurse-specific, all-registrant standard comparable in clarity to Alberta’s physician standard. The concern is not the absence of every form of protection but the absence of a clearly defined regulatory pathway for all Alberta RNs and NPs. Methods: Publicly available legal, occupational health and safety, regulatory, legal-risk and scholarly materials were purposively selected where they addressed relationship termination, discontinuing or declining care, workplace violence, immediate safety risk, abandonment, documentation, continuity of care or patient safeguards. Results: The College of Physicians and Surgeons of Alberta standard provides a clearly defined regulatory pathway, including immediate discharge where a patient poses a safety risk, is abusive or fails to respect professional boundaries. Alberta nursing materials contain important elements but do not yet constitute a dedicated Alberta RN/NP standard applicable across office-based, community, virtual, home care and independent nursing practice. Interprovincial nursing standards demonstrate feasibility, operational detail, emerging professional consensus and potential templates for policy transfer; however, they do not bind the CRNA or create an Alberta regulatory benchmark for complaint review. Conclusions: Alberta should adopt a nurse-specific standard for ending or restricting abusive patient- and family-initiated relationships. Such a standard should include ordinary and urgent safety pathways, prohibited grounds, documentation requirements, continuity safeguards, employer integration and practical templates. Nurse protection and patient protection are mutually reinforcing regulatory objectives.