Search

Interrupted time series (ITS) studies are frequently used to examine the impact of population-level interventions or exposures. Systematic reviews with meta-analyses including ITS designs may inform public health and policy decision-making. Re-analysis of ITS may be required for inclusion in meta-analysis. While publications of ITS rarely provide raw data for re-analysis, graphs are often included, from which time series data can be digitally extracted. However, the accuracy of effect estimates calculated from data digitally extracted from ITS graphs is currently unknown. Forty-three ITS with available datasets and time series graphs were included. Time series data from each graph was extracted by four researchers using digital data extraction software. Data extraction errors were analysed. Segmented linear regression models were fitted to the extracted and provided datasets, from which estimates of immediate level and slope change (and associated statistics) were calculated and compared across the datasets. Although there were some data extraction errors of time points, primarily due to complications in the original graphs, they did not translate into important differences in estimates of interruption effects (and associated statistics). Using digital data extraction to obtain data from ITS graphs should be considered in reviews including ITS. Including these studies in meta-analyses, even with slight inaccuracy, is likely to outweigh the loss of information from non-inclusion.

Interrupted time series (ITS) are often meta-analysed to inform public health and policy decisions but examination of the statistical methods for ITS analysis and meta-analysis in this context is limited. We simulated meta-analyses of ITS studies with continuous outcome data, analysed the studies using segmented linear regression with two estimation methods [ordinary least squares (OLS) and restricted maximum likelihood (REML)], and meta-analysed the immediate level- and slope-change effect estimates using fixed-effect and (multiple) random-effects meta-analysis methods. Simulation design parameters included varying series length; magnitude of lag-1 autocorrelation; magnitude of level- and slope-changes; number of included studies; and, effect size heterogeneity. All meta-analysis methods yielded unbiased estimates of the interruption effects. All random effects meta-analysis methods yielded coverage close to the nominal level, irrespective of the ITS analysis method used and other design parameters. However, heterogeneity was frequently overestimated in scenarios where the ITS study standard errors were underestimated, which occurred for short series or when the ITS analysis method did not appropriately account for autocorrelation. The performance of meta-analysis methods depends on the design and analysis of the included ITS studies. Although all random effects methods performed well in terms of coverage, irrespective of the ITS analysis method, we recommend the use of effect estimates calculated from ITS methods that adjust for autocorrelation when possible. Doing so will likely to lead to more accurate estimates of the heterogeneity variance.

To ensure equitable representation of women and BIPOC (Black, Indigenous, person of colour) individuals in surgical specialties, it is first necessary to understand the presence and extent of the disparities that exist. We explored the websites of the 17 Canadian faculties of medicine to examine sex and racial diversity in surgical specialties and in surgical leadership positions in Canada. We categorized faculty members of each department of surgery as either male or female and White or BIPOC. The relative percentage of female academic surgeons was very low compared with Canadian demographic data, and the relative percentage of BIPOC academic surgeons was similar to Canadian demographic data. Our observations suggest that actions must be taken to improve diversity and inclusion in surgery., Sex and racial diversity is becoming an increasingly important topic in today's society. American studies have reported a deficit of women and racial minorities among physicians, including those in leadership [...]

Background: The Continuing Professional Development (CPD) (Education) Committee of the Canadian Association of Thoracic Surgeons (CATS) has established a goal of describing the essential knowledge of thoracic surgery. We aimed to develop a national standardized set of undergraduate learning objectives for thoracic surgery. Methods: We obtained these learning objectives from 4 medical schools in Canada. These 4 institutions were selected to provide a broad geographical representation of medical schools of varying sizes and of both official languages. The resulting list of learning objectives underwent critical review by the CPD (Education) Committee, made up of 5 Canadian community and academic thoracic surgeons, 1 thoracic surgery fellow and 2 general surgery residents. A national survey was developed and circulated to all CATS members (n = 209). Respondents were asked to indicate on a 5-point Likert scale whether each objective should be a priority for all medical students. Results: Among 209 CATS members, 56 responded (response rate 27%). The mean length of experience in clinical practice among survey respondents was 10.6 (standard deviation 10.0) years. Respondents most commonly reported teaching or supervising medical students monthly (37.0%), followed by daily (29.6%). Eight of the 10 proposed objectives received a mean Likert score of 4/5 or higher and were selected for inclusion in the final list. A finalized list of 8 learning objectives was created, following a final review from the CATS Executive Committee. Conclusion: We developed a standardized set of learning objectives for medical students that was reflective of the core concepts within thoracic surgery. Contexte: Le comité de développement professionnel continu (DPC) (Formation) de l'Association canadienne de chirurgie thoracique (ACCT) a fixé l'objectif de décrire les connaissances essentielles à l'exercice de la chirurgie thoracique. Nous avions pour but d'établir un ensemble d'objectifs d'apprentissage normalisé à l'échelle nationale en chirurgie thoracique destiné aux étudiants de premier cycle. Méthodes: Quatre écoles de médecine canadiennes nous ont fourni ces objectifs d'apprentissage. Nous avons sélectionné les 4 établissements afin d'obtenir une large représentation géographique des écoles de médecine, de tailles différentes et ancrées dans les 2 langues officielles. La liste d'objectifs d'apprentissage que nous avons obtenue a fait l'objet d'une évaluation critique du comité de DPC (Formation), composé de 5 chirurgiens thoraciques canadiens provenant des milieux communautaires et universitaires, 1 stagiaire postdoctoral et 2 résidents en chirurgie générale. Nous avons élaboré une enquête nationale et l'avons soumise à l'ensemble des membres de l'ACCT (n = 209). Les personnes répondantes devaient indiquer sur une échelle de Likert en 5 points si chacun des objectifs devait constituer une priorité pour toutes les personnes étudiant en médecine. Résultats: Parmi les 209 membres de l'ACCT, 56 ont répondu (taux de réponse de 27%). L'étendue moyenne de l'expérience en pratique clinique des personnes ayant répondu à l'enquête était de 10,6 ans (écart-type de 10,0 ans). Les personnes répondantes ont plus souvent mentionné enseigner ou superviser des personnes étudiant en médecine sur une base mensuelle (37,0%), suivi d'une base quotidienne (29,6%). Huit des 10 objectifs proposés ont obtenu un score de Likert moyen d'au moins 4/5; nous les avons sélectionnés pour les intégrer à la liste finale. Nous avons créé une liste finale composée de 8 objectifs d'apprentissage à la suite d'une dernière révision par le comité de direction de l'ACCT. Conclusion: Nous avons élaboré un ensemble normalisé d'objectifs d'apprentissage destiné aux personnes étudiant en médecine qui se veut le reflet des concepts fondamentaux de la chirurgie thoracique., Medical students often have limited exposure to subspecialty surgery (including thoracic surgery) over the course of their education. At best, select students may have the opportunity to rotate through this [...]

Background: Despite guidelines recommending diagnostic laparoscopy in patients with gastric cancer, implementation is low. We aimed to explore trends in the use of laparoscopy for staging of gastric cancer in Alberta, Canada, determine the rate of positive findings and identify factors predictive of positive staging laparoscopy (SL) findings in this patient population. Methods: In August 2018, we sent a survey to all general surgeons in Alberta who were members of the Alberta Association of General Surgeons to identify those treating gastric cancer. The survey inquired about type of practice (academic or community), gastric cancer case volume, routine versus selective use of SL and, if selective use of SL, criteria used to select cases. Participants were also asked to provide data from their SL cases from July 2007 to February 2019. We double-checked surgeon records with chart review. The primary outcome was evidence of metastatic disease on SL or cytologic examination or both. We performed logistic regression analysis to identify factors predictive of positive laparoscopy findings. Results: The survey was completed by 41 of 127 surgeons (response rate 32.3%). We reviewed 116 cases from 5 surgeons at 4 centres. Gross metastatic disease or positive findings on cytologic examination or both were identified in 37 patients (31.9%). On univariate analysis, the following were associated with an increased risk of identification of metastatic disease at laparoscopy: visualization of the primary tumour on computed tomography (CT) (odds ratio [OR] 9.8, 95% confidence interval [CI] 1.2-76.5), presence of abdominal lymphadenopathy greater than 1 cm (OR 2.4, 95% CI 1.1-5.4) and presence of ascites (OR 19.1, 95% CI 2.2-161.8). Visualization of the primary tumour on CT (OR 8.4, 95% CI 1.0-68.3) and the presence of ascites (OR 15.9, 95% CI 1.8-137.0) remained statistically significant predictors on multivariate analysis. Conclusion: Metastatic disease was identified at SL in almost one-third of cases, which suggests that SL should still be used routinely in gastric cancer staging in Canadian centres. Our study identified several preoperative imaging findings associated with evidence of metastatic disease on laparoscopy; however, further studies are needed to establish robust predictors of positive findings before advocating for a selective SL approach. Contexte : Bien que les directives recommandent une laparoscopie diagnostique chez les patients atteints d'un cancer de l'estomac, cette intervention est peu utilisee. Nous avons voulu explorer les tendances du recours a la laparoscopie pour la stadification du cancer de l'estomac en Alberta, au Canada, etablir le taux de resultats positifs et cibler les facteurs predictifs de resultats positifs de la laparoscopie de stadification dans cette population de patients. Methodes : En aout 2018, nous avons envoye un sondage a tous les chirurgiens generaux de l'Alberta membres de l'Alberta Association of General Surgeons pour savoir lesquels traitaient le cancer de l'estomac. L'enquete portait sur le type de pratique (universitaire ou communautaire), le volume de cas de cancer de l'estomac, le recours systematique ou selectif de la laparoscopie de stadification et, en cas de recours selectif, les criteres de selection. Les participants ont egalement ete invites a fournir des donnees sur les cas ou la laparoscopie de stadification avait ete utilisee de juillet 2007 a fevrier 2019. Nous avons reverifie les dossiers des medecins. Le principal indicateur etait la presence d'une maladie metastatique lors de la laparoscopie de stadification ou de l'examen cytologique (ou les deux). Nous avons procede a une analyse de regression logistique pour cerner les facteurs predictifs de resultats positifs a la laparoscopie. Resultats : Sur 127 chirurgiens 41 ont repondu au sondage (taux de reponse de 32,3 %). Nous avons examine 116 cas traites par 5 chirurgiens dans 4 centres. Une maladie metastatique brute ou des resultats positifs a l'examen cytologique ou les deux ont ete identifies chez 37 patients (31,9 %). Une analyse univariee a revele que les elements suivants etaient associes a un risque accru d'identification de maladie metastatique lors de la laparoscopie : visualisation de la tumeur primaire a la tomodensito-metrie (TDM) (rapport des cotes [RC] 9,8, intervalle de confiance [IC] de 95 % 1,2-76,5), presence d'une lymphadenopathie abdominale superieure a 1cm (RC 2,4, IC de 95 % 1,1-5,4) et presence d'ascite (RC 19,1, IC de 95 % 2,2-161,8). La visualisation de la tumeur primaire a la TDM (RC 8,4, RC de 95 % 1,0-68,3) et la presence d'ascite (RC 15,9, RC de 95 % 1,8-137,0) sont demeurees des facteurs predictifs statistiquement significatifs dans l'analyse multivariee. Conclusion : Une maladie metastatique a ete identifiee a la laparoscopie de stadification dans pres d'un tiers des cas, ce qui suggere que la laparoscopie de stadification devrait con inuer d'etre utilisee de facon systematique dans la stadification du cancer de l'estomac dans les centres canadiens. Notre etude a montre plusieurs resultats d'imagerie preoperatoire associes a des signes de maladie metastatique a la laparoscopie; cependant, d'autres etudes sont necessaires pour etablir des predicteurs solides de resultats positifs avant de preconiser une approche selective de la laparoscopie de stadification., Gastric cancer remains the fifth most common cancer diagnosed worldwide and the third most common cause of cancer-related death. (1) In Canada, the incidence of gastric adenocarcinoma is estimated to [...]

Introduction: Interrupted Time Series (ITS) studies may be used to assess the impact of an interruption, such as an intervention or exposure. The data from such studies are particularly amenable to visual display and, when clearly depicted, can readily show the short- and long-term impact of an interruption. Further, well-constructed graphs allow data to be extracted using digitizing software, which can facilitate their inclusion in systematic reviews and meta-analyses. Aim: We provide recommendations for graphing ITS data, examine the properties of plots presented in ITS studies, and provide examples employing our recommendations. Methods and results: Graphing recommendations from seminal data visualization resources were adapted for use with ITS studies. The adapted recommendations cover plotting of data points, trend lines, interruptions, additional lines and general graph components. We assessed whether 217 graphs from recently published (2013-2017) ITS studies met our recommendations and found that 130 graphs (60%) had clearly distinct data points, 100 (46%) had trend lines, and 161 (74%) had a clearly defined interruption. Accurate data extraction (requiring distinct points that align with axis tick marks and labels that allow the points to be interpreted) was possible in only 72 (33%) graphs. Conclusion: We found that many ITS graphs did not meet our recommendations and could be improved with simple changes. Our proposed recommendations aim to achieve greater standardization and improvement in the display of ITS data, and facilitate re-use of the data in systematic reviews and meta-analyses.

Background: Interrupted time series (ITS) studies contribute importantly to systematic reviews of population‐level interventions. We aimed to develop and validate search filters to retrieve ITS studies in MEDLINE and PubMed. Methods: A total of 1017 known ITS studies (published 2013–2017) were analysed using text mining to generate candidate terms. A control set of 1398 time‐series studies were used to select differentiating terms. Various combinations of candidate terms were iteratively tested to generate three search filters. An independent set of 700 ITS studies was used to validate the filters' sensitivities. The filters were test‐run in Ovid MEDLINE and the records randomly screened for ITS studies to determine their precision. Finally, all MEDLINE filters were translated to PubMed format and their sensitivities in PubMed were estimated. Results: Three search filters were created in MEDLINE: a precision‐maximising filter with high precision (78%; 95% CI 74%–82%) but moderate sensitivity (63%; 59%–66%), most appropriate when there are limited resources to screen studies; a sensitivity‐and‐precision‐maximising filter with higher sensitivity (81%; 77%–83%) but lower precision (32%; 28%–36%), providing a balance between expediency and comprehensiveness; and a sensitivity‐maximising filter with high sensitivity (88%; 85%–90%) but likely very low precision, useful when combined with specific content terms. Similar sensitivity estimates were found for PubMed versions. Conclusion: Our filters strike different balances between comprehensiveness and screening workload and suit different research needs. Retrieval of ITS studies would be improved if authors identified the ITS design in the titles. [ABSTRACT FROM AUTHOR]