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There is a strong and growing focus on self-determination in French-speaking countries, and this pilot study reports the technical adequacy of the Self-Determination Inventory: Student Report (SDI:SR) French Translation. Data were collected with 471 French-speaking youth with and without disabilities in Canada (Quebec), Switzerland, France, and Belgium. Key findings showed it was feasible to use 20 (of 21) items to represent the self-determination construct in the French-speaking sample. The same set of items function in the same way across students with and without disabilities, and students with disabilities descriptively scored lower. Overall, this study provides promising evidence for reliability and validity of the SDI:SR French Translation and suggests ongoing development and larger-scale testing of the SDI:SR French Translation is warranted.

An appreciative inquiry approach oriented eight semi-structured interviews conducted with teachers from Australia, New Zealand, Austria, Italy, Spain, Canada, Bangladesh and India to identify their intrinsic and extrinsic strengths and understand how they were able to translate them into practice during the first COVID-19 lockdown in 2020. Commitment and determination, collegial support and solidarity were some of the common driving forces identified, despite the differences in teachers' backgrounds, education systems, policies and cultures. Our research sheds light on opportunity solving in times of crisis as well as on the way education systems worldwide can renew themselves to ensure innovative and inclusive quality education.

This piece draws on multiple voices to reflect on a collaborative project between university-based researchers and a local community organization devoted to Indigenous Blackfoot children and their families. The evolution of the project from one based on photo-elicitation to one devoted to building a digital storytelling library meant a methodological shift to acknowledge the role of translation in encounters between university researchers and community practitioners, between Elders and youth, and between settlers and Indigenous people. Our experience provides lessons on the importance of taking seriously the moments when difference is encountered and translated during the research and community-building process.

Purpose: The purpose of this scoping review is to assess the literature on allied health professions escape rooms (AHPERs), investigating their common purposes and practices, and the trends in scholarship. Methods: This scoping review followed PRISMA-ScR guidelines to assess the size and scope of evidence in the literature, categorize common purposes and practices, and explore trends in AHPER scholarship. Two reviewers developed a review protocol, collected literature using a search strategy aligned with inclusion criteria, and charted review results. Results: The literature search yielded 6,170 articles. After the final review, 34 unique records met inclusion criteria. Studies were conducted in the United States, Spain, Australia, France, Brazil, and Canada. Most escape rooms reported participants, team size, puzzle type, and outcomes, but few used causal research designs, primarily using pre-post with no control designs. AHPERs represent an increasingly popular pedagogical approach. AHPERs tend to be simply structured, patient themed, and convey either disciplinary or interprofessional lessons. Generally, AHPERs were self-reported as effective and satisfying, but scholarship supporting AHPERs was insufficient in design for causal claims. Conclusion: Developers and scholars may benefit from considering frameworks and guidelines for consistent creation and increased trustworthiness in the AHPER practice and knowledge base. Where AHPER scholars can increase attention to learning outcomes, and plan scholarly works in advance of the escape room, the AHPER body of knowledge will increase. [ABSTRACT FROM AUTHOR]

This study investigates the relationships between the observed quality of classroom teaching assessing Atmosphere, Instruction, Management and Student Engagement, ("AIMS," Roehrig, A. D., and E. Christesen. 2010. 'Development and Use of a Tool for Evaluating Teacher Effectiveness in Grades K-12.' In "Innovative Assessment for the 21st Century," edited by V. J. Shute, and B. J. Becker, 207-228. New York, NY: Springer), and growth in reading and listening comprehension across grade 4 in typical English-French dual language learners. For the majority, (67%), English was a first language (L1), for 16% French was an L1. N = 332 children in 36 classrooms were assessed on reading and listening comprehension measures and observed in the fall and winter semesters in English and French. Results showed that, overall, ratings of AIMS sub-scales did not differ markedly across English and French classrooms. Classroom teaching quality ratings were not, however, correlated across English and French classes. AIMS ratings in either language for Atmosphere were reliable and relatively stable between fall and winter, as was Management in English. AIMS ratings predicted growth in classroom-level variance in reading and listening for English and French both concurrently and longitudinally. These results suggest that there are broad, stable commonalities in effective teaching in English and French classrooms that can be validly and reliably observed. Practically, such observations of (majority) second language teaching quality can facilitate assessment of student needs and mentoring and development needs of teachers.

Background: Progressive supranuclear palsy (PSP) is a rare neurodegenerative brain disease with rapid progression and currently limited treatment options. A comprehensive understanding of disease progression, management, and healthcare resource utilization is limited, and further research is challenging due to the small population of patients. To address these challenges in conducting PSP research, individuals with PSP were recruited using a multichannel approach tailored specifically to the PSP community. We performed a retrospective observational study using data abstracted from participant medical records collected from multiple patient care centers. Results: Seventy-two individuals with PSP were eligible for inclusion. On average, 144 medical documents per participant were collected from an average of 2.9 healthcare centers per participant, with a mean study period of 7.9 years. Among participants with a date of symptom onset documented in the medical records, the median time for the onset of the first fall was 2.0 years (IQR 3.2) before diagnosis, the median onset of unsteady gait or gait impairment was 1.2 years (IQR 1.8) before diagnosis, and the median onset of mobility problems was 0.8 years (IQR 1.8) before diagnosis. The most widely utilized healthcare resources, with at least 85% of participants using each of these resources at some point during the disease course, were medications (100%), imaging (99%), assistive devices (90%), supportive care (86%), and surgeries and procedures (85%). Conclusions: This retrospective study adds to the current understanding of PSP symptoms, comorbidities, and healthcare resource utilization (HRU) across the disease journey. By involving individuals with PSP and their caregivers or legally authorized representatives in the research process, this study was unique in its approach to participant recruitment and enabled individuals to participate in research without the need for travel. We collected medical documents from multiple healthcare centers, allowing for broad data collection covering the entire disease journey. This approach to the collection of real-world data may be used to generate valuable insights into many aspects of disease progression and management in PSP and many other rare diseases. [ABSTRACT FROM AUTHOR]

Summary : Long wait times for elective surgery in Canada have been a persistent problem for many years and the recent pandemic has made the situation substantially worse. Current evidence suggests that ambulatory surgery centres are more cost-effective and efficient in the delivery of ambulatory surgical services than larger institutions. We explore the merits of a network of publicly funded ambulatory surgery centres. [ABSTRACT FROM AUTHOR]

Background: Moving toward a funding standard similar to that for clinical services for roles essential to the functioning of education, research and leadership services within divisions of general surgery is necessary to strengthen divisional resilience. We aimed to identify roles and underlying tasks in these services central to sustainable functioning of Canadian academic divisions of general surgery.Methods: Between June 2018 and October 2020, we used a 4-step modified Delphi method (online survey, face-to-face nominal group technique [n = 12], semistructured telephone interview [n = 8] and nominal group technique [n = 12]) to achieve national consensus from an expert panel of all 17 heads of academic divisions of general surgery in Canada on the roles and accompanying tasks essential to education, research and leadership services within an academic division of general surgery. We used 70% agreement to determine consensus.Results: The expert panel agreed that a framework for role allocation in education, research and leadership services was relevant and necessary. Consensus was reached for 7 roles within the educational service, 3 roles within the research service and 5 roles within the leadership service.Conclusion: Our framework represents a national consensus that defines role standards for education, research and leadership services in Canadian academic divisions of general surgery. The framework can help divisions build resiliency, and enable sustained and deliberate advances in these services. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Surgery is the property of CMA Impact Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To investigate the current headache medicine education paradigm in allopathic and osteopathic medical schools in the United States and Canada. Background: There is a disparity in the number of clinicians specially trained to treat patients with headache disorders and the number of people who have them. Early education and exposure to headache medicine is crucial to address this disparity. However, the current state of headache education within medical schools across the United States and Canada is unknown. Methods: The authors created a medical student headache education survey, which is a 20‐question REDCap survey that was distributed via email to the neurology clerkship director, curriculum dean, or similar role at each US and Canadian MD or DO conferring medical school. The email listserv was created using the American Academy of Neurology Clerkship Directory, the Association of American Medical Colleges Organization Directory, the American Association of College of Osteopathic Medicine Organization Directory, manual searches of the institutions' websites, and phone calls and emails to administrators as needed. Results: Of the 249 individuals contacted, 78 completed the survey, yielding a response rate of 31.3%. Of those responses, 84.6% of respondents (66/78) reported that their institution has at least one mandatory session on headache disorders. Many of these sessions (72.7% (48/78)) occurred during preclinical training, and 74.2% (49/78) occurred as part of the clinical curricula. Of respondents, 44.9% (39/78) reported that their institutions coordinate headache education across training levels (i.e., from preclinical to clinical), and only 17.9% (14/78) coordinate across clinical rotations. The most common topics covered were headache red flags, migraine, pharmacologic management, and differentiating primary versus secondary headache. 65.4% of respondents (51/78) felt that the preclinical headache curriculum prepares their students for the clinical experience, and 55.1% (43/78) felt that medical students were learning enough about headache medicine at their institution. Barriers to educating medical students about headache included insufficient time during courses, lack of administrative support in curricula development, lack of available resources, and lack of student interest. Case‐based learning modules and online lectures were the most desired educational materials to improve medical student headache education at their institution. Conclusions: The majority of medical schools report incorporating headache medicine education into preclinical or clinical curricula and cover a range of topics in headache medicine. Yet there remains a lack of consistency, with some reporting limited headache education, citing barriers such as lack of administrative support and available educational resources. There is also variation in what is being taught at the medical student level. Future projects should aim to address said barriers, with the goal of providing a standardized headache medicine curriculum for use across medical schools. [ABSTRACT FROM AUTHOR]

Describes founding, goals, admissions, and implementation of a five-year Micmac Bachelor of Social Work Program at Dalhousie University. Discusses advantages and problems of a decentralized program sponsored by diverse organizations/agencies. Outlines degree requirements, staff qualifications, student personal/financial needs, and program changes to meet needs of Native adult learners. (LFL)

The conjoint association of gestational diabetes mellitus (GDM) and gestational hypertension (GH) with cardiometabolic disease has not been well studied. We evaluated a combined GDM/GH risk indicator in both mothers and fathers because of shared spousal behaviors and environments. In the present population-based retrospective cohort study, GH was identified in matched pairs of mothers with GDM or without GDM (matched on age group, health region, and year of delivery) who had singleton live births in Quebec, Canada (1990-2007). A total of 64,232 couples were categorized based on GDM/GH status (neither, either, or both). Associations with diabetes, hypertension, and a composite of cardiovascular disease (CVD) and mortality were evaluated using Cox proportional hazard models (from 12 weeks postpartum to March 2012). Compared with having neither GDM nor GH, having either was associated with incident diabetes (hazard ratio (HR) = 14.7,95% confidence interval (CI): 12.9,16.6), hypertension (HR = 1.9,95% CI: 1.8,2.0), and CVD/mortality (HR = 1.4,95% CI: 1.2,1.7). We found associations of greater magnitude among participants who had both (for diabetes, HR = 36.9, 95% CI: 26.0, 52.3; for hypertension, HR = 5.7, 95% CI: 4.9, 6.7; and for CVD/mortality, HR = 2.4, 95% CI: 1.6,3.5). Associations with diabetes were also observed in fathers (for either, HR = 1.2,95% CI: 1.1,1.3; for both, HR = 1.8, 95% CI: 1.4,2.3). In conclusion, we found associations of a combined GDM/GH indicator with cardiometabolic disease in mothers and with diabetes in fathers, with stronger associations when both GDM and GH were present. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Surgery is the property of CMA Impact Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article looks at the cost reduction offered by ambulatory percutaneous nephrolithomy (aPCNL) in the healthcare system in Canada. It notes that aPCNL represents a new option for urologists to consider in the surgical management of nephrolithiasis, citing the established safety and efficacy of aPCNL according to previously published criteria in case series. A comparison of the surgical aspect of aPCNL to standard PCNL is discussed.

Objective--To evaluate the role of prophylactic versus selective ureteric stenting in the development of postoperative ureterovesical complications in kidney transplant recipients. Methods--Records of 614 transplant patients seen from January 2006 to May 2011 were retrospectively reviewed. The primary outcome was the rate of ureterovesical complications, defined as the development of ureteric obstruction or a ureterovesical anastomotic leak. The secondary outcomes were the rate of urinary tract infections and forgotten stents. Using a χ2 test, we compared the primary and secondary outcomes across the selective and prophylactic cohorts. Logistic regression was used to compare the 2 cohorts while adjusting for potential confounders. Results--The selective and prophylactic cohorts consisted of 258 and 330 patients, respectively. Unadjusted analysis showed that the prophylactic group had a significantly lower rate of ureterovesical complications than did the selective group (2.12% vs 6.20%; odds ratio, 0.33; P= .01). After adjustment for differences in sex and donor type, the prophylactic group still had a lower risk for ureterovesical complications (odds ratio, 0.30; P= .009). Rates of urinary tract infections and forgotten stents did not differ significantly between the 2 groups. Conclusions--Prophylactic stenting is associated with a significantly lower rate of ureterovesical complications than is selective stenting. [ABSTRACT FROM AUTHOR]

The article details a study which examined if any of the nine polymorphisms in five candidate genes are associated with severe liver disease in patients diagnosed with cystic fibrosis (CF). The study included 124 patients with CF and severe liver disease with portal hypertension (CFLD) from centers in the U.S., Canada and outside of North America and 843 control subjects. The differences in the distribution of genotypes in the study population were analyzed. Study authors found that SERPINA1 Z allele is a risk factor for the development of liver disease in patients with CF.

Objectives: Kikuchi-Fujimoto disease (KFD) is a rare, benign, self-limiting condition occasionally associated with systemic lupus erythematosus (SLE). Although rising in incidence, nonspecific symptoms make diagnosis difficult. We present a small case series and review the literature to increase awareness of this condition among otolaryngologists. Methods: Nine cases of KFD were diagnosed between 2003 and 2006 at the McGill University Health Care institution by either excisional or fine-needle biopsy. Clinical and histologic features were reviewed in the context of a comprehensive analysis of the KFD literature. Results: Seven of nine cases are female, with a mean age of 27.2 years (range 18-35 years). Only one patient had systemic SLE predating KFD. Our results are comparable to those in the current literature regarding the association with SLE. Conclusions: We present the first Canadian small case series and extensive review of the literature to highlight the clinical and pathologic features of this disease and its association with SLE. [ABSTRACT FROM AUTHOR]

Introduction: With the rapidly evolving techniques for minimally invasive surgery (MIS), general surgeons are challenged to incorporate advanced procedures into their practices. We therefore carried out a study to assess the state of MIS practice in Ontario. Methods: A questionnaire was mailed to 390 general surgeons in Ontario. It addressed the surgeon's practice demographics, performance of both basic and advanced MIS procedures, the factors influencing this practice and the means of obtaining MIS training. Results: Of the 390 general surgeons surveyed, 309 (79%) responded. Thirty-six of these were retired and were excluded from the analysis, leaving 273 available for study. The average age in the study group was 49.7 years; 247 (90%) were men. Of 272 who responded to the question, 116 (43%) had subspecialty training. The average surgeon's operating room (OR) time was 1.5 d/wk and the aver-age waiting time for elective procedures was 4 weeks. We found that 257 (94%) respondents performed basic laparoscopic procedures, and 164 (60%) performed appendectomy; 135 (49%) performed at least 1 advanced laparoscopic procedure in their practice, although only 30 (22%) of these performed inguinal hernia repair. Using a Likert scale, we found that the most important factors influencing the incorporation of advanced laparoscopic procedures into surgical practice were a lack of OR time (median 4), lack of OR financial resources (median 4) and lack of training opportunities (median 4). Of surgeons responding to questions, 161 (64%) of 251 felt that the present medical environment did not allow them to meet standard-of-care requirements; they felt that it was the responsibility of academic surgical departments (214 [80%] of 268), the Canadian Association of General Surgeons (177 [68%] of 262) and the Ontario Association of General Surgeons (141 [53%] of 264) to provide continuing medical education courses for MIS training. Conclusion: The ability of practising. [ABSTRACT FROM AUTHOR]

Introduction: The differential outcomes of laparoscopic adrenalectomy are not well described. Therefore, we evaluated these outcomes in the 3 groups most often seen clinically: bilateral adrenatectomy for Cushing's disease (group 1), pheochromocytoma (group 2) and unilateral adrenalectomy for non-pheochromocytoma (group 3). Methods: We reviewed a longitudinal database of 72 consecutive cases of laparoscopic adrenalectomy carried out between 1997 and 2001 at the Centre for Minimally Invasive Surgery, University of Toronto. Results: Patients in group 1 tended to be older (median 49 yr) and heavier (median 87 kg). They had a longer operating time (median 255 min), more postoperative complications (15%) and a longer median postoperative stay (4 d). Patients in group 2 had intermediate outcomes: a median operating time of 198 minutes, complication rate of 8.3% and a median postoperative hospital stay of 3 days. However, they had more intraoperative blood loss (median 150 mL). Group 3 patients had the best outcomes with the shortest median operating time (125 min), least blood loss (median 50 mL), fewer complications (6%) and shortest hospital stay (median 2 d). Conclusions: Although the outcomes of laparoscopic adrenalectomy are uniformly good, on the basis of the underlying pathologic characteristics, patients can be divided into groups that have different expected outcomes. Patients requiring a unilateral adrenalectomy except for pheochromocytoma have the best recorded outcomes. Surgeons transferring to laparoscopic adrenalectomy would benefit from selecting patients in this group during their learning curve. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to assess the state of surgical training in minimally invasive surgery (MIS) within Canadian academic surgical departments. Methods: A pretested questionnaire was distributed to the general surgery residents of participating Canadian academic surgical departments. Results: Fourteen of 16 residency programs participated and 235 of 388 residents (60%) responded to the survey. Residents expect to perform both basic (217/235 [92%]) and advanced (123/234 [53%]) MIS procedures on completion of their residency. However, only 41 of 233 (18%) believed that their advanced MIS training would be adequate. On a Likert scale, the most important factors influencing their training included limited advanced case volume (median, 5), limited opportunity in the operating room (OR) (median, 5), lack of attending surgeon interest (median, 4), limited OR time (median, 4), and a lack of surgical department support (median, 4). Residents were concerned about their ability to acquire these skills once they finished their training (median, 4), and 231 of 234 (99%) thought that there was an important role for a MIS surgeon within the academic setting (median, 5). Conclusion: The rapid development of MIS has generated complex issues for resident training within the present Canadian academic surgical environment. [ABSTRACT FROM AUTHOR]

Simple Summary: This study aims to quantify the effects of smoke originating from boreal biomass-burning fires on solar radiation propagating through the atmosphere. The wildfires that took place in summer 2017 along Greenland's west coast and northern Canada produced a considerable amount of particles that were transported north and northeast, respectively, and were detected at the Thule High Arctic Atmospheric Observatory (THAAO; 76.53 ∘ N, 68.74 ∘ W). Solar radiation measurements carried out at THAAO, satellite data, and modeled radiations allowed the estimation of surface cooling and the warming aloft at two atmospheric layers (at altitudes of approximately 5 and 11 km asl) due to the presence of the biomass-burning aerosol particles. Boreal fires have increased during the last years and are projected to become more intense and frequent as a consequence of climate change. Wildfires produce a wide range of effects on the Arctic climate and ecosystem, and understanding these effects is crucial for predicting the future evolution of the Arctic region. This study focuses on the impact of the long-range transport of biomass-burning aerosol into the atmosphere and the corresponding radiative perturbation in the shortwave frequency range. As a case study, we investigate an intense biomass-burning (BB) event which took place in summer 2017 in Canada and subsequent northeastward transport of gases and particles in the plume leading to exceptionally high values (0.86) of Aerosol Optical Depth (AOD) at 500 nm measured in northwestern Greenland on 21 August 2017. This work characterizes the BB plume measured at the Thule High Arctic Atmospheric Observatory (THAAO; 76.53 ∘ N, 68.74 ∘ W) in August 2017 by assessing the associated shortwave aerosol direct radiative impact over the THAAO and extending this evaluation over the broader region ( 60 ∘ N– 80 ∘ N, 110 ∘ W– 0 ∘ E). The radiative transfer simulations with MODTRAN6.0 estimated an aerosol heating rate of up to 0.5 K/day in the upper aerosol layer (8–12 km). The direct aerosol radiative effect (ARE) vertical profile shows a maximum negative value of −45.4 Wm − 2 for a 78 ∘ solar zenith angle above THAAO at 3 km altitude. A cumulative surface ARE of −127.5 TW is estimated to have occurred on 21 August 2017 over a portion (∼ 3.1 × 10 6 km 2 ) of the considered domain ( 60 ∘ N– 80 ∘ N, 110 ∘ W– 0 ∘ E). ARE regional mean daily values over the same portion of the domain vary between −65 and −25 Wm − 2 . Although this is a limited temporal event, this effect can have significant influence on the Arctic radiative budget, especially in the anticipated scenario of increasing wildfires. [ABSTRACT FROM AUTHOR]

Addresses issues related to workforce planning and modeling in the 21st century for the field of urology in Ontario. Balance between future needs for urology services and future supply of urologists; Projected shortage of urologists by 2010; Requirements of training programs to help minimize the estimated shortage.

Increased expression of developmentally silenced fetal globin (HBG) reduces the clinical severity of β-hemoglobinopathies. Benserazide has a relatively benign safety profile having been approved for 50 years in Europe and Canada for Parkinson's disease treatment. Benserazide was shown to activate HBG gene transcription in a high throughput screen, and subsequent studies confirmed fetal hemoglobin (HbF) induction in erythroid progenitors from hemoglobinopathy patients, transgenic mice containing the entire human β-globin gene (β-YAC) and anemic baboons. The goal of this study is to evaluate efficacies and plasma exposure profiles of benserazide racemate and its enantiomers to select the chemical form for clinical development. Intermittent treatment with all forms of benserazide in β-YAC mice significantly increased proportions of red blood cells expressing HbF and HbF protein per cell with similar pharmacokinetic profiles and with no cytopenia. These data contribute to the regulatory justification for development of the benserazide racemate. Additionally, dose ranges and frequencies required for HbF induction using racemic benserazide were explored. Orally administered escalating doses of benserazide in an anemic baboon induced γ-globin mRNA up to 13-fold and establish an intermittent dose regimen for clinical studies as a therapeutic candidate for potential treatment of β-hemoglobinopathies. • Fetal hemoglobin induction for individuals living with β-hemoglobinopathies are most feasible via pharmacologic approaches. • Racemate (R,S) -Benserazide and its enantiomers induce fetal globin expression in vivo in β-YAC transgenic mice. • A clinical trial of (R,S)-Benserazide in patients with hemoglobin disorders was initiated based on the findings. [ABSTRACT FROM AUTHOR]

Aims: TransFORmation of IndiGEnous PrimAry HEAlthcare Delivery (FORGE AHEAD) partnered with local clinical and community teams in 11 First Nations (FN) communities across Canada to develop quality improvement (QI) initiatives aimed at improving T2DM.Methods: Pre-post mixed-methods case study design was used. The 18-month intervention included community and clinical readiness, development of a community diabetes registry and clinical system, and QI activities. Participants consisted of community members, 18 yrs and older, with diabetes. Changes in clinical outcomes and clinical practice guideline (CPG) recommendations were assessed pre and post intervention using multilevel regression (patients nested within communities) adjusted forindividual andcommunity baseline characteristics.Results: No significant change in HbA1c orsBP, but a small reduction indBP(-0.75 mmHg, p < 0.05) and LDL (-0.09 mmol/L, p < 0.05) was observed in 2008 adults with T2DM (mean age: 60·5 (SD:14·6) years; female: 57·2%). Individuals not at CPG targets at baseline had significant reductions in: %HbA1c (N = 616): -0.40 (95%CI:-0·55,-0·24),sBP (N = 561): -7·67 mmHg (95%CI:-9·23, -5·72),dBP (N = 291): -7·46 mmHg (95%CI:-8·69, -6·26), LDL (N = 450): -0·37mmo/l (95%CI:-0·44, -0·29).Annual HbA1c (OR: 1·95; 95%CI:1·66, 2·29), BP (OR: 1·78; 95%CI:1·52, 2·09), LDL (OR: 1·27; 95%CI:1·10, 1·47) and CKD screening (OR: 6·37; 95%CI:5·16, 7·92)increased but retinopathy screening decreased (OR: 0·68; 95%CI:0·57, 0·82). No significant change in foot exams (OR: 0·97; 95%CI:0·76, 1·23) or BMI recordings (OR: 0·96; 95%CI:0·82, 1·12) was seen. Overall, individualsweremorelikely to receive ≥75% of CPG recommended services compared to baseline (OR: 1·51; 95%CI:1·27, 1·80).Conclusions: FORGE AHEAD is the first Canadian study to demonstrate that a FN community-led QI intervention can lead to diabetes improvements. [ABSTRACT FROM AUTHOR]

Background: The training of surgeons and residents in laparoscopic surgery has become an important issue. The purpose of this study is to determine if the training of a laparoscopic fellow affects outcomes in patients undergoing laparoscopic splenectomy (LS).Methods: Data were obtained from a prospectively collected database of patients who underwent LS from August 1994 to November 1999. Outcomes of the last 25 cases, performed by fellows under supervision, were compared to 25 cases performed by staff surgeons prior to the introduction of fellows.Results: Patient demographics, preoperative platelet count, and splenic size were similar for the two groups. Outcome measures comparing the staff and the fellows group including operative time (151 vs 178 min, p = 0.055), blood loss (214 vs 162 ml, p = 0.40), intraoperative complications (3 vs 2, p = 1.0), need for transfusion (2 vs 3, p = 1.0), conversions (1 vs 0, p = 1.0), length of hospital stay (3.3 vs 2.5 days, p = 0.13), and postoperative complications (1 vs 2, p = 1.0) were similar for the two groups.Conclusion: When performed by a fellow under supervision, LS has the same outcomes as when the procedure is performed by the teaching staff surgeon. [ABSTRACT FROM AUTHOR]

The article presents a commentary on deep sedation for colonoscopy. Topics discussed include administration of anesthesia and propofol for colonoscopy, cost of colonoscopy and anesthesia services in Canada and the U.S., and decrease in sedation usage and improvement in adenoma detection rates associated with the use of water exchange during colonoscope insertion.

Introduction: Following the introduction of shock wave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL), the subspecialty of endourology was born in the late 1970s. The purpose of this study was to report milestones in Canadian endourology, highlighting Canada's contributions to the field. Methods: A review of the literature was performed from the late 1970s to the present. The literature review included bibliographic and digital resources. Additionally, records and recollections by various individuals were used, including some who were directly involved. Results: Endourology was born in Canada when SWL, URS, and PCNL emerged as minimally invasive treatment options for stones in the early to mid-1980s. According to our research, the first PCNL was performed at the University of Toronto in 1981. Dr. Joachim Burhenne, a Harvard-trained radiologist from Germany, first used extracorporeal SWL in Canada at the University of British Columbia (UBC) for the treatment of biliary stones. Treatment for urinary tract stones followed at UBC and Dalhousie University. The first worldwide use of the holmium laser for lithotripsy of urinary tract calculi took place at the University of Western Ontario. Other endourology milestones in Canada include the formation of the Canadian Endourology Group and the emergence of the Endourological Society-accredited fellowship programs at the University of Toronto and Western University in the 1990s. Canada hosted the 21st and 35th World Congress of Endourology and Shock Wave Lithotripsy annual meeting in Montreal and Vancouver, respectively. Conclusions: Canadian urologists have led many advances in SWL, URS, and PCNL over the past four decades and, for a relatively small community, have made significant contributions to the field. Through the training of the next generation of endourologists at Canadian institutions, the future of endourology in Canada is bright. [ABSTRACT FROM AUTHOR]

Background: We describe the practice variability of CUA (Canadian Urological Association) members and factors which predict these patterns for common stone scenarios. Methods: We asked 308 English- and 52 French-speaking CUA members to complete online surveys in their respective languages. We collected demographic information on fellowship training, shock wave lithotripsy (SWL) access, academic setting and whether they are at a hospital with regionalized surgical services. Respondents indicated their actual as well as ideal treatment for scenarios of renal, proximal and distal ureteric calculi . Results: In total, 131 urologists responded (36% response rate), all of whom treated urolithiasis. Of this number, 17% had endourology fellowship training, 76% had access to SWL, 42% were at an academic institution and 66% were at institutions with regionalized surgical services. Actual and ideal treatment modalities selected for symptomatic, distal and proximal ureteric stones (4, 8, 14 mm) were consistent with published guidelines. There were discrepancies between the use of ureteroscopy and SWL in actual versus ideal scenarios. Actual and ideal practices were congruent for proximal ureteric stones and asymptomatic renal calculi. In multivariate analysis, respondents were less likely to perform ureteroscopy on proximal 4- and 8-mm stones if they were at a hospital with regionalized surgical services (OR: 0.097; 95% Cl: O.Dl-0.76, p = 0.03 and OR: 0.330; 95% Cl: 0.1 3-0.83, p = 0.02). Interpretation: There is clinical variability in the management of urolithiasis in Canada; however, management approaches fall within published guidelines. Type of hospital and access to operating room resources may affect treatment modality selection. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The script concordance test (SCT) is an innovative tool for clinical reasoning assessment. It has previously been shown to be a reliable and valid measure of clinical reasoning among general surgical residents. Purpose: To determine if the SCT maintained its validity and reliability when administered on a national level. Methods: The test was administered to 202 residents (51 R1, 45 R2, 45 R3, 28 R4, and 33 R5) in 9 general surgery programs across Canada. Results: The optimized version of the test had a reliability (Cronbach alpha) of .85. Scores increased progressively from R1 (64.5 ± 7.6) to R2 (69.5 ± 5.8) to R3 (69.9 ± 6.7) to R4 (72.0 ± 6.2) with a dip in the R5s (68.3 ± 8.6). The test was able to differentiate junior (R1+ R2 = 66.8 ± 7.2) from senior residents (R3 + R4 + R5 = 70.0 ± 7.3, P = .001) across all the programs. Conclusions: The SCT maintained its reliability and validity as a measure of intraoperative clinical reasoning among general surgical residents when administered across multiple centers. We believe that the SCT can be developed to measure clinical reasoning in high-stakes national examinations. [Copyright &y& Elsevier]