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Canadian Journal of Surgery. Journal Canadien de Chirurgie

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https://www.readbyqxmd.com/read/30265646/significant-cost-savings-and-similar-patient-outcomes-associated-with-early-discharge-following-total-knee-arthroplasty
#1
Jacquelyn Marsh, Lyndsay Somerville, James L Howard, Brent A Lanting
BACKGROUND: A substantial portion of the cost of total knee arthroplasty (TKA) results from the postoperative inpatient length of stay (LOS). Considering the annual increase in TKAs, reducing LOS represents a potential for cost savings. We sought to compare in-hospital costs and patient-reported outcomes for an early discharge protocol compared with the standard LOS following TKA. METHODS: We conducted a retrospective matched cohort study, matching patients on age, sex, body mass index and preoperative Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) score...
October 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30265645/the-state-of-transcatheter-aortic-valve-implantation-training-in-canadian-cardiac-surgery-residency-programs
#2
Derrick Y Tam, Ahmed Makhdoum, Maral Ouzounian, Harindra C Wijeysundera, Gideon N Cohen, Stephen E Fremes
BACKGROUND: The current state of transcatheter aortic valve implantation (TAVI) training for Canadian cardiac surgical residents is unknown. Our goals were to establish a national inventory of TAVI educational resources, elucidate the role of residents in TAVI programs, and determine the attitudes and perspectives of residents and program directors regarding the importance of TAVI technology and training. METHODS: We sent Web-based surveys and reminders to all Canadian cardiac surgical residents and program directors between February and July 2017...
October 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30265644/surgical-management-of-benign-phyllodes-tumours-of-the-breast-is-wide-local-excision-really-necessary
#3
Yiming Qian, May Lynn Quan, Travis Ogilvi, Antoine Bouchard-Fortier
Current guidelines recommending wide local excision (≥ 1 cm margin) for all breast phyllodes tumours regardless of classification are based on retrospective data. Benign phyllodes tumours of the breast are not aggressive. They are often indistinguishable from fibroadenomas on core biopsy and are diagnosed only after excisions without attention to margins. Once the diagnosis is made, the decision to operate and obtain further margins versus wait-and-watch is the dilemma breast surgeons face on a regular basis...
October 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30265643/results-of-octaplex-for-reversal-of-warfarin-anticoagulation-in-patients-with-hip-fracture
#4
Richard Ng, Meer-Taher Shabani-Rad
BACKGROUND: Patients with hip fracture who present anticoagulated with warfarin often require reversal of anticoagulation for safe hip fracture surgery. Vitamin K is typically administered for this, but requires 24-48 hours for maximal effect. These patients have an increased delay to surgery and increased mortality. Octaplex is a prothrombin complex concentrate (PCC) that reverses warfarin anticoagulation in less than an hour. This study assesses the effectiveness and safety of Octaplex for reversal of warfarin anticoagulation for hip fracture surgery...
October 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30265642/cost-of-open-and-laparoscopic-distal-gastrectomy-surgeon-perceptions-versus-the-reality-of-hospital-spending
#5
Liza Abraham, Nik Goyert, Daniel J Kagedan, Andrea MacNeill, Michelle C Cleghorn, Julie Hallet, Fayez A Quereshy, Natalie G Coburn
BACKGROUND: Rising health care costs have led to increasing focus on cost containment and accountability from health care providers. We sought to explore surgeon awareness of supply costs for open and laparoscopic distal gastrectomy. METHODS: Surveys were sent in 2015 to surgeons at 8 academic hospitals in Toronto who performed distal gastrectomy for gastric adenocarcinoma. Respondents were asked to estimate the total cost, type and number of disposable equipment pieces required to perform open and laparoscopic distal gastrectomy...
October 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30265641/concordance-between-laboratories-in-metal-ion-testing-in-patients-with-metal-on-metal-hip-implants
#6
Raghav Saini, Pam Railton, Jessica Boyd, Hossein Sadrzadeh, James N Powell
BACKGROUND: Testing of whole blood or serum metal ion levels has become an important part of assessing and monitoring the performance of metal-on-metal bearings, both in hip resurfacing arthroplasty and in total hip replacement. The aim of this study was to determine the concordance between 2 laboratories testing cobalt and chromium ion levels in patients with metal-on-metal bearings. METHODS: Serum and whole blood samples from patients who had undergone metal-on-metal resurfacing or large-diameter total hip arthroplasty were tested for cobalt and chromium ions in laboratory A (a recognized laboratory) and laboratory B (tasked with testing clinical specimens)...
October 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30265640/comparison-of-knot-tying-proficiency-and-knot-characteristics-for-square-and-reversing-half-hitch-alternating-post-surgical-knots-in-a-simulated-deep-body-cavity-among-notice-medical-students
#7
Vincent Wu, Cynthia Yeung, Edward A Sykes, Boris Zevin
BACKGROUND: Proficiency-based knot-tying curricula have been developed for square knots for medical students, but, to our knowledge, no such curriculum exists for the reverse half hitch alternating-post (RHAP) knot. We aimed to compare medical students' knot-tying proficiency, knot-tying self-confidence and final knot characteristics for RHAP and square knots in a simulated deep body cavity. METHODS: We performed a within-subject prospective crossover study of novice medical students who received 30 minutes of training in tying both RHAP and square knots...
October 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30265639/-hockey-wrist-dorsal-ulnotriquetral-ligament-injury
#8
Emilie Sandman, Mathieu Boily, Paul A Martineau
BACKGROUND: Ulnar-sided wrist pain at the dorsal proximal triquetrum, especially during wrist pronation, flexion and radial deviation, is common in athletes, particularly ice hockey players. The purpose of this study was to evaluate in which position the dorsal ulnotriquetral ligament (DUTL) is placed under the greatest strain, the torque to failure and the injury pattern. We hypothesized that the DUTL is maximally strained with wrist flexion, pronation and radial deviation, and that, at failure, the ligament tears off the triquetrum...
October 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30265638/optimizing-outpatient-total-hip-arthroplasty-perspectives-of-key-stakeholders
#9
Laura Churchill, Michael Pollock, Yekaterina Lebedeva, Nicholas Pasic, Dianne Bryant, James Howard, Brent Lanting, Debbie Laliberte Rudman
BACKGROUND: Advances in surgical techniques combined with multimodal analgesia and early rehabilitation have potentiated early mobilization in patients undergoing total hip arthroplasty (THA). Given an increasing push from patients to accelerate recovery and health care budgetary limitations, there has been growing interest in the implementation of outpatient THA in selected patients. Understanding the patient and primary caregiver experience of outpatient THA is important to optimize care...
October 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30265637/high-complication-rate-among-patients-undergoing-appendectomy-in-ontario-a-population-based-retrospective-cohort-study
#10
Sunil V Patel, Sulaiman Nanji, Susan B Brogly, Katherine Lajkosz, Patti A Groome, Shaila Merchant
BACKGROUND: Appendectomy is a common emergency procedure. The risks have been reported in previous studies but often are limited to inpatient complications. The purpose of this study was to describe inpatient and outpatient rates of complications associated with appendectomy in a contemporary population-based cohort and explore factors associated with these complications. METHODS: We conducted a retrospective study using linked data for Ontario within Institute for Clinical Evaluative Sciences databases...
October 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30265636/effect-of-rater-training-on-the-reliability-of-technical-skill-assessments-a-randomized-controlled-trial
#11
Reagan L Robertson, Ashley Vergis, Lawrence M Gillman, Jason Park
BACKGROUND: Rater training improves the reliability of observational assessment tools but has not been well studied for technical skills. This study assessed whether rater training could improve the reliability of technical skill assessment. METHODS: Academic and community surgeons in Royal College of Physicians and Surgeons of Canada surgical subspecialties were randomly allocated to either rater training (7-minute video incorporating frame-of-reference training elements) or no training...
October 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30265635/surgical-treatment-choices-for-breast-cancer-in-newfoundland-and-labrador-a-retrospective-cohort-study
#12
Farah McCrate, Elizabeth Dicks, Erin Powell, Joanne Chafe, Rebecca Roome, Charlene Simmonds, Holly Etchegary
BACKGROUND: Mastectomy is often chosen by women for treatment of breast cancer, even when breast-conserving surgery (BCS) is an option. Newfoundland and Labrador has a high mastectomy rate. We documented the number of breast cancers over a given period in the province and their related surgical treatments, and explored the impact of several variables on surgical choice. METHODS: A retrospective cohort design linked diagnosis data from the Newfoundland and Labrador tumour registry to surgery data from the Canadian Institute for Health Information Discharge Abstract Database...
October 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30418010/novel-use-of-facetime-video-calling-in-a-deployed-setting-to-assist-with-the-care-of-a-military-working-dog
#13
Benjamin Donham, Megan Lee Wickett
In deployed settings, veterinary recourses are limited and nonveterinary medical providers frequently are required to provide medical treatment to military working dogs (MWDs) until veterinary specialty care can be provided. We present the case of a critically ill MWD who presented initially to a Canadian NATO Role II facility in Iraq that lacked immediate veterinary support. Through the use of FaceTime interactive video calling, the Role II medical providers were able to consult with the MWD unit’s veterinarian in the United States and provide effective evaluation, treatment and prioritization of medical evacuation (MEDEVAC)...
December 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30418009/reflections-on-recovery-rehabilitation-and-reintegration-of-injured-service-members-and-veterans-from-a-bio-psychosocial-spiritual-perspective
#14
Markus Besemann, Jacqueline Hebert, James M. Thompson, Rory A. Cooper, Gaurav Gupta, Suzette Brémault-Phillips, Sarah J. Dentry
Medical interventions regarding trauma resuscitation have increased survivorship to levels not previously attained. Multiple examples from recent conflicts illustrate the potential return to high-level function of severely injured service members following medical and rehabilitative interventions. This review addresses the goals of rehabilitation, distills hard-won lessons of the last decade of military trauma and rehabilitation, and recommends the use of a bio-psychosocial-spiritual approach to care that can be applied at all tiers of the health care system...
December 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30418008/the-effect-of-aerosolized-indomethacin-on-lung-inflammation-and-injury-in-a-rat-model-of-blunt-chest-trauma
#15
Raymond L. Kao, Weixiong Huang, Claudio M. Martin, Tao Rui
Background: Acute lung contusion from blunt chest trauma (BCT) is characterized by an intense inflammatory response in the pulmonary parenchyma, which is associated with acute lung injury (ALI), acute respiratory distress syndrome and ventilator-associated pneumonia. We hypothesized that aerosolized indomethacin may reduce pulmonary inflammation and ALI in a rat model of BCT. Methods: Sprague-Dawley rats were anesthetized and received a tracheotomy for administration of aerosolized medication through a catheter...
December 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30418007/impact-of-traumatic-upper-extremity-amputation-on-the-outcome-of-injury-caused-by-an-antipersonnel-improvised-explosive-device
#16
Shane A. Smith, Mark P. DaCambra, Vivian C. McAlister
Background: We have previously reported a higher than expected rate of upper-extremity amputation (UEA) in victims of an antipersonnel improvised explosive device (AP-IED) compared with a similar cohort injured by antipersonnel mines (APM). The goal of this study was to describe the rate, severity and impact of UAE caused by an AP-IED. Methods: We analyzed a prospective database of 100 consecutive dismounted AP-IED victims with pattern 1 injuries to compare the outcomes of the cohort with UEA to that without...
December 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30418004/utilization-profile-of-the-canadian-led-coalition-role-2-medical-treatment-facility-in-iraq-the-growing-requirement-for-multinational-interoperability
#17
Mark P. DaCambra, Raymond L. Kao, Christopher Berger, Vivian C. McAlister
Background: The Canadian Armed Forces deployed a Role 2 Medical Treatment Facility (R2MTF) to Iraq in November 2016 as part of Operation IMPACT. We compared the multinational interoperability required of this R2MTF with that of similar facilities previously deployed by Canada or other nations. Methods: We reviewed data (Nov. 4, 2016, to Oct. 3, 2017) from the electronic Disease and Injury Surveillance Report and the Daily Medical Situation Report. Clinical activity was stratified by Global Burden of Diseases category, ICD-10 code, mechanism of injury, services used, encounter type, nationality and blood product usage...
December 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30417720/a-novel-reboa-system-prototype-and-proof-of-concept
#18
Shane A. Smith, Vivian C. McAlister
Background: Lower torso hemorrhage is a significant cause of death from injuries in combat. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to rescue patients successfully in the hospital setting, but its prehospital use is controversial. We designed a device that would be easy to use, safer in injured vessels, migration-resistant and amenable to a prehospital environment. Methods: We designed a novel, balloon-led device using common commercial materials...
December 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30417639/care-of-victims-of-suicide-bombing
#19
Raymond L. Kao, Vivian C. McAlister
Suicide bombers often target crowds. This commentary discusses the additional features required in a medical response beyond conventional mass casualty care, including forensic documentation, preservation of evidence, suspect tissue identification and viral status, victim counselling and postexposure prophylaxis. We propose a pathway for care of victims of a suicide bomb, adapting elements from protocols for child abuse, sexual assault and needle-stick exposure.
December 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/30417638/proposed-specifications-of-a-mobile-operating-room-for-far-forward-surgery
#20
John Leasiolagi, Troy Holton, Kate Doyle, Laura Parkinson, Raymond Kao, Vivian C. McAlister
Provision of initial surgery to casualties within one hour of injury is associated with better survival. Where evacuation options are limited, surgery within the “golden hour” may have to occur close to the point of injury. Interventions close to the point of injury are limited by the adverse environment. Far-forward surgery has a long history going back to Dominique Larrey of the Napoleonic Army. We reviewed previous reports and used our own experience of far-forward surgery to describe the specifications of the ideal mobile operating room that would address some of these environmental barriers...
December 1, 2018: Canadian Journal of Surgery. Journal Canadien de Chirurgie
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