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Objective: To determine whether the incidence of pregnancy and live birth is similar in women of childbearing age undergoing abdominal myomectomy (AM) with the use of a pericervical tourniquet compared with women undergoing AM without the use of a tourniquet. Design: A multicenter retrospective cohort study was conducted, consisting of a retrospective chart review and a self-administered questionnaire on reproductive outcomes. Methods: Women of childbearing age (18–45 years old) who underwent AM at two tertiary care centers between June 2002 and 2012 were consecutively sampled. Unadjusted and multivariable regression analyses were used to compare the two groups. Results: In total, 1097 patients met inclusion criteria and 160 returned the questionnaire. After excluding patients who did not attempt to conceive postoperatively, 82 patients were included in the final statistical analysis. Twenty-eight percent of surgeries involved use of pericervical tourniquet. Unadjusted analysis did not identify a significant association between the use of tourniquet and incidence of live birth (p = 0.35), postoperative pregnancy (p = 0.98), or length of time attempting conception after surgery (p = 0.80). After adjusting for age, parity, whether uterine cavity was entered, and number of fibroids, there was no significant difference in incidence of live birth or postoperative pregnancy between the two groups. Conclusion: Our study suggests no significant association between use of tourniquet and pregnancy and live birth rates. Concerns about the tourniquet's impact on fertility may, therefore, be unfounded, and more widespread uptake of pericervical tourniquet during AM may contribute to limiting surgical blood loss. Further prospective research is warranted with larger sample sizes. [ABSTRACT FROM AUTHOR]

Study objective: To determine the pre-operative evaluation, surgical management and referral practices in patients with advanced stage endometriosis by Canadian gynaecologists. Design: A survey of obstetricians and gynaecologists. Setting: The survey was initiated and piloted at an academic centre by general gynaecologists and endometriosis specialists. Intervention: Electronically distributed to 733 individuals by the Society of Obstetricians and Gynaecologists of Canada. This included all members, irrespective of subspecialty and practice patterns. Measurement: Responses were collected using a web-based survey tool and analysed using Excel. Results: The response rate was 15.7% (115 respondents). Pre-operatively, 62.2% of respondents perform a transvaginal ultrasound on all of their patients, while magnetic resonance imaging is reserved for patients with physical exam findings suspicious for advanced endometriosis (26.7%) or in whom the surgeons suspect deep infiltrating endometriosis, bowel, bladder or uterosacral disease (54.4%). Most surgeons (81.4%) report encountering advanced disease that they did not suspect pre-operatively <10% of the time. Although 40% of respondents would refer their patients in whom they suspected deep infiltrating endometriosis, endometriomas, bowel, bladder or uterosacral ligament involvement to an endometriosis specialist prior to any attempted surgery, 54.4% would never refer without previously confirming the diagnosis at laparoscopy. In contrast, only 15% felt comfortable treating advanced endometriosis completely at time of laparoscopy (including deep infiltrating endometriosis, bladder and bowel disease). Post-operatively, 67.8% of respondents refer patients to an endometriosis specialist only if their disease was not appropriately treated surgically, while 23.3% do not refer any of their patients. Conclusion: Our study identified significant variability in the management of advanced endometriosis in Canada. Understanding these patterns will help us formulate a more universal investigation and management plan, which may improve the identification of patients pre-operatively with advanced stage endometriosis that could benefit from treatment by an endometriosis specialist. [ABSTRACT FROM AUTHOR]

Introduction: The World Health Organization (2017) issued a call to improve health system performance through better coordination and integrated care. However, "the literature does not contain a one-size-fits-all model or process for successful integration, nor is there a firm empirical foundation for integration strategies and processes" (Suter et al., 2009). To implement effective inter-sectoral collaboration requires political will and innovative solutions to build communication across sectors to address local population needs (WHO, 2017). In 2017, 76 new cross-sectoral teams or "Tables" were created in Ontario (Canada) to address local population health needs. This provided a unique opportunity to conduct research to learn "how to" enable health systems integration and transformation through collaboration among diverse stakeholders. In this research, six "Tables" were studied; two were "Rural Tables", two were "Suburban Tables", and two were "Urban Tables") from 2018-2019. Aim/Objectives/Theories/Methods: The aim of this study was to understand the patterns of communication and collaboration among the participants of six "Tables". This research was innovative as it used both Relational Coordination and Complexity Theories in the context of health systems integration and transformation. The objectives were: 1)To identify key success factors/challenges to understand "how to" build cross-sectoral collaboration for leaders. 2)To develop a policy framework on "how to" build cross-sectoral collaboration for health systems integration/transformation for policymakers. A mixed-methods approach was used with Methodological Triangulation, which included quantitative surveys (at baseline and follow-up), qualitative interviews and member checking. Highlights/Results/Key Findings: The survey response rate was 62% at Baseline (n=45) and 25% at Follow-up (n=22). Relational Coordination Index Scores were "moderate" with no significant differences between Baseline and Follow-up and no differences between the stakeholders or "Tables". From the twelve interviews, it was discovered that context matters at the local levels. "Rural Tables" with "moderate" Relational Coordination reported "inter-dependency" and the "Suburban Tables" with "weak" Relational Coordination reported "inter-organizational challenges". The findings characterized the process of intentional cross-sectoral collaboration using both Relational Coordination and Complexity theories to understand the patterns of communication and collaboration among the stakeholders and the "Tables". This research was unique as the stakeholders collaborated voluntarily and were self-organized without any formal governance or structural changes, interventions, accountability targets or measurement of outcomes. This research adds a much-needed knowledge on cross-sectoral collaboration for leaders and policymakers in the development of self-organizing capacity supported by Relational Coordination. Conclusion: A policy framework on "how to" build cross-sectoral collaboration for health systems integration/transformation has been developed. The framework includes engaging with patients/families and key stakeholders, assessing relational coordination and structures, addressing health care as a complex adaptive system, and evaluation. Even though these proposed strategies are novel, further research is needed to drive health systems integration. Implications: In the literature, there is no one-size-fits-all model for health systems integration. Based on this conundrum, it is recommended that leaders view health care as a Complex Adaptive System; to allow the system to transform, change, and to develop inter-dependencies, interorganizational relationships and self-organizing capacities. Lessons learned from health systems integration in Canada are shared. [ABSTRACT FROM AUTHOR]

The use of magnetic resonance imaging (MRI) during pregnancy is associated with concerns among patients and health professionals with regards to fetal safety. In this work, the Canadian Association of Radiologists (CAR) Working Group on MRI in Pregnancy presents recommendations for the use of MRI in pregnancy, derived from literature review as well as expert panel opinions and discussions. The working group, which consists of academic subspecialty radiologists and obstetrician-gynaecologists, aimed to provide updated, evidence-based recommendations addressing safety domains related to energy deposition, acoustic noise, and gadolinium-based contrast agent use based on magnetic field strength (1.5T and 3T) and trimester scanned, in addition to the effects of sedative use and occupational exposure. [ABSTRACT FROM AUTHOR]

Objective: To survey all gynaecologists in Canada to determine the number who perform or offer the laparoscopic myomectomy (LM) procedure, the barriers that deter gynaecologists from performing or offering LM, and to understand the perceptions and attitudes of Canadian gynaecologists with respect to LM., Methods: A survey was developed, pre-tested, and distributed to all 1279 obstetrician-gynaecologists on the SOGC mailing list in April 2007., Results: A total of 529 obstetrician-gynaecologists participated in the survey a response rate of 41.4%. Of the 485 respondents who practised gynaecology, 119 (24.5%) performed LM, but only 15 (3.1%) stated that more than 50% of their myomectomies were performed laparoscopically. Two hundred twelve gynaecologists (44.3%) admitted to having referred a patient to another gynaecologist for LM. Laparoscopic surgeons felt the principal barrier to performing LM was lack of training in the procedure (70.7%). Gynaecologists felt the principal barrier to referring to another gynaecologist for LM was their uncertainty about who offered the procedure (33%). The majority of gynaecologists believed that LM has faster recovery time. The majority of respondents, however, were unsure which procedure is superior with respect to blood loss, adhesion formation, fertility rate post-procedure, uterine rupture rate in subsequent pregnancy, and cost-effectiveness., Conclusion: Despite existing evidence that indicates that LM is comparable to abdominal myomectomy with respect to complication rates and fertility, only one quarter of Canadian gynaecologists who responded to this survey performed the procedure. Barriers to performing LM included lack of training and barriers to referral included uncertainty about who offered the procedure.