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Background: Despite prevention efforts, type 2 diabetes mellitus continues to increase in incidence among First Nations children and is associated with early and aggressive complications. We aimed to determine the experiences of adolescents living with type 2 diabetes and the barriers to living well with type 2 diabetes that adolescents perceived., Methods: We recruited adolescents with type 2 diabetes mellitus from the pediatric diabetes clinic in Winnipeg, Manitoba, to participate in a day-long facilitated focus group discussion. Group discussions were recorded and transcribed verbatim. We used interpretive description methodology to inform the thematic analysis of the transcripts., Results: Eight adolescents with a mean age of 15 years participated. Five adolescents identified as female; most were Indigenous (7/8). The mean duration since diagnosis of diabetes was 2.5 years. Adolescents reported struggling with acceptance of their diagnosis, with the stigma and shame associated with the diagnosis and with daily self-management tasks. Three themes were developed from the focus group discussions: bearing witness, the "weight" of diabetes and support (lack of support)., Interpretation: Adolescents with diagnoses of type 2 diabetes experience associated stigma and shame, which are substantial barriers to self-care. A broader understanding of their lived experience, including the socioecological and emotional context, could help to improve health care provision and intervention strategies for this population., Competing Interests: Competing interests: None declared., (© 2021 Joule Inc. or its licensors.)

Objective: To report the intraoperative surgical outcomes and safety of femtosecond laser-assisted cataract surgery (FLACS) during surgeon learning curve and compare those outcomes with those of conventional phacoemulsification in a Canadian public hospital setting., Design: Retrospective chart review., Participants: FLACS and phacoemulsification patients at Brandon Regional Health Centre, Brandon, Manitoba, Canada., Methods: Intraoperative surgical outcomes and safety (rates of intraoperative complications and phacoemulsification parameters) were compared among 3 groups: the first consecutive 197 cases using femtosecond laser (FSL) pretreatment to ultrasound phacoemulsification in cataract surgery (group 1; early FLACS), the second consecutive 165 cases using FSL (group 2; later FLACS), and 80 consecutive conventional cataract surgery cases (group 3; conventional phaco)., Results: There was a statistically significant difference for phacoemulsification parameters (actual phaco time [APT], effective phaco time [EPT], and ultrasound average) among the 3 groups (all p-values < 0.05). The mean phacoemulsification parameters (APT and EPT) for the early FLACS and the conventional phaco groups were significantly longer than those for the later FLACS group (p < 0.05). The mean FSL time for the early FLACS group was significantly longer than that for the later FLACS group. There was no statistical difference among the rates of intraoperative complications (suction breaks, capsular tags, FSL-induced miosis, posterior capsular tears, and anterior vitrectomy) for the 3 groups., Conclusions: During the learning curve, the intraoperative outcomes and safety of FLACS are comparable to the conventional phacoemulsification technique. After the learning curve, FLACS is significantly superior to conventional surgery in all measured phacoemulsification parameters., (Copyright © 2019 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the feasibility, effectiveness, and reproducibility of femtosecond laser (FSL) technology in different corneal cuts., Design: Experimental study at the Brandon Regional Health Centre., Participants: Twenty two Human Cadaver eyes donated for research and supplied by the eye bank of Manitoba university., Methods: In this experimental study, the effectiveness and reproducibility of FSL were investigated in different corneal cuts. The corneas were divided into 5 groups: group I for penetrating keratoplasty; group II for anterior lamellar keratoplasty; group III for corneal pockets for inlays; group IV for intracorneal ring tunnels; and group V for corneal cross-linking pockets. Our primary endpoint was the repeatability of planned versus obtained thickness and diameter of the cuts with FSL. A secondary endpoint was the effectiveness and ease of dissection, rated from 0-4, with 4 being the easiest and 0 the most difficult to dissect., Results: There was a high correlation between planned and obtained thickness (r = 0.997, p < 0.001) and diameter (r = 0.998, p < 0.001). Both were statistically significant. Linear regression analyses showed that the obtained thickness of corneal cuts in micrometers was significantly predicted by the planned thickness of corneal cuts in micrometers (β = 0.996, t = 56.47, p < 0.001). Likewise, the obtained diameter of corneal cuts in millimeters was significantly predicted by the planned diameter of corneal cuts in millimeters (β = 0.971, t = 70.85, p < 0.001). The surgeons gave 15 out of a total of 22 corneas (68.2%) the maximum score for ease of dissection (Grade 4), where no adhesions were found and the dissection was smooth and steady. Five corneas out of a total of 22 (22.7%) were given a score of 3 of 4 where minor adhesions were found. Two corneas out of a total of 22 (9.1%) were given a score of 2 of 4 where >1 adhesion was found, with some difficulty in separating the cut cornea from the bed. No corneas were given grade 1 or grade 0. No significant differences were obtained for the ease of dissection among the 5 surgery types using Kruskal-Wallis H test (H [4] = 4.971, p > 0.05)., Conclusion: The measured corneal-cut geometry correlated well with laser settings in a variety of full- and partial-thickness FSL corneal patterns, including different depths and diameters. This reproducible efficacy and measurement accuracy of the planned versus obtained cuts could have a favourable result on a variety of corneal surgeries. It also yields a favourable ease of dissection of the cut lenticule from the stromal bed., (Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the time needed to perform a femtosecond laser-assisted cataract surgery (FLACS) and its effect on the efficiency of cataract surgery flow in a Canadian public health centre., Design: Retrospective chart review., Participants: Patients who had cataract surgery performed in the first 3 months of femtosecond laser (FSL) technology use were compared with patients who had conventional phacoemulsification in the 3 months before FSL installation at Brandon Regional Health Centre (Brandon, Man.)., Methods: The primary outcome measure was the time needed to complete FLACS versus the time needed to complete conventional phacoemulsification. Secondary outcome measures were the time the patient spent in the operating room (time in and time out) and the number of cataract surgeries done per surgical day before and after FSL was implemented systemwide., Results: There were 235 FSL cases and 199 conventional cases. Operating room time, total surgery time, and manual time were significantly longer in patients who underwent FLACS compared with patients who underwent conventional phacoemulsification (p < 0.001). Manual times and FSL suction times on the first day of implementing FLACS surgery were significantly longer than those on day 23 (p < 0.03), which suggests a learning curve effect. The number of cases per surgical day dropped by 28.6% in the first operative day and by 7.1% in the second and third operative days of FSL use, then reverted to pre-FSL levels., Conclusion: The addition of FLACS results in longer time per case than traditional cataract surgery. Although statistically significant, the results may not be indicative of practical differences., (Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)