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Background: As the prevalence of chemotherapy‐related cognitive impairment rises, investigation into treatment options is critical. The objectives of this study were to test the effects of an aerobic exercise intervention initiated during chemotherapy compared to usual care (wait list control condition) on (1) objectively measured cognitive function and self‐reported cognitive function, as well as on (2) the impact of cognitive impairment on quality of life (QOL) postintervention (commensurate with chemotherapy completion). Methods: The Aerobic exercise and CogniTIVe functioning in women with breAsT cancEr (ACTIVATE) trial was a two‐arm, two‐center randomized controlled trial conducted in Ottawa and Vancouver (Canada). Fifty‐seven women (Mage, 48.8 ± 10 years) diagnosed with stage I–III breast cancer and awaiting chemotherapy were randomized to aerobic exercise initiated with chemotherapy (nEX = 28) or usual care during chemotherapy with aerobic exercise after chemotherapy completion (nUC = 29). The intervention lasted 12–24 weeks and consisted of supervised aerobic training and at‐home exercise. The primary outcome was objective cognitive function measured via 13 neuropsychological tests (standardized to M ± SD, 0 ± 1); secondary outcomes of self‐reported cognitive function and its impact on QOL were assessed via questionnaires. Data collected pre‐ and postintervention (the primary end point) were analyzed. Results: Although no significant differences between groups were found for objective cognitive function outcomes postintervention after accounting for multiple testing, four of six self‐reported cognitive function outcomes showed significant differences favoring the aerobic exercise group. Conclusions: Among women initiating chemotherapy for breast cancer, aerobic exercise did not result in significant differences in objective cognitive function postintervention after chemotherapy completion; however, the results do support the use of this intervention for improving self‐reported cognitive function and its impact on QOL. As the prevalence and consequences of chemotherapy‐related cognitive impairment rise, investigation into treatment options for patients is critical. Findings of this randomized controlled trial support the use of a 12‐ to 24‐week aerobic exercise intervention for women initiating chemotherapy for breast cancer to improve self‐reported cognitive function and its impact on QOL. [ABSTRACT FROM AUTHOR]

Background Accurate tools to distinguish Crohn's disease [CD] from cryptoglandular disease in patients with perianal fistulas without detectable luminal inflammation on ileocolonoscopy and abdominal enterography (isolated perianal fistulas [IPF]) are lacking. We assessed the ability of video capsule endoscopy [VCE] to detect luminal inflammation in patients with IPF. Methods We studied consecutive adults [>17 years] with IPF who were evaluated by VCE after a negative ileocolonoscopy and abdominal enterography between 2013 and 2022. We defined luminal CD by VCE as diffuse erythema, three or more aphthous ulcers, or a Lewis score greater than 135. We compared rates of intestinal inflammation in this cohort with age- and sex-matched controls without perianal fistulas, who underwent VCE for other indications. We excluded persons with pre-existing inflammatory bowel disease [IBD] and exposure to non-steroidal anti-inflammatory drugs or immunosuppressive treatments. Results A total of 45 patients with IPF underwent VCE without complications. Twelve patients [26%] met our definition of luminal CD. Luminal CD was more common in patients with IPF than in controls [26% vs 3%; p  <0.01]. Among patients with IPF, male sex (OR [odds ratio], 9.2; 95% confidence interval [CI] [1.1-79.4]), smoking (OR, 4.5; 95% CI [0.9-21.2]), abscess (OR, 6.3; 95% CI [1.5-26.8]), rectal enhancement on magnetic resonance imaging [MRI] (OR, 9.0; 95% CI [0.8-99.3]), and positive antimicrobial serology (OR, 7.1; 95% CI, [0.7-70.0]) were more common in those with a positive VCE study. Conclusions VCE detected small intestinal inflammation suggestive of luminal CD in approximately one-quarter of patients with IPF. Larger studies are required to validate these findings. [ABSTRACT FROM AUTHOR]

Background: Despite recent advances in arthroscopic rotator cuff repair, the retear rate remains high. New methods to optimize healing rates must be sought. Bone channeling may create a quicker and more vigorous healing response by attracting autologous mesenchymal stem cells, cytokines, and growth factors to the repair site. Hypothesis: Arthroscopic rotator cuff repair with bone channeling would result in a higher healing rate compared with arthroscopic rotator cuff repair without adjuvant channeling. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Our primary objective was to compare healing rates in patients undergoing arthroscopic rotator cuff repair for degenerative tears, with and without bone channeling. Secondary objectives included comparisons of the Western Ontario Rotator Cuff Index (WORC) score, American Shoulder and Elbow Surgeons (ASES) score, Constant score, Constant strength subscore, and visual analog scale (VAS) for pain score between groups. Patients undergoing arthroscopic rotator cuff repair were recruited at 3 sites and were randomized to receive either bone channeling augmentation or standard repair. Healing was determined via ultrasound at 24 months postoperatively. WORC, ASES, and Constant scores were compared between groups at baseline and at 3, 6, 12, and 24 months postoperatively. Results: A total of 168 patients were enrolled between 2013 and 2018. Intention-to-treat analysis revealed no statistical differences in healing rates between the 2 interventions at 24 months postoperatively. Statistically significant improvements occurred in both groups from preoperatively to all time points for the WORC, the ASES score, the Constant score or Constant strength subscore, and the VAS for pain (P <.0001). No differences were observed between the bone channeling and control groups in WORC, ASES, Constant, and VAS pain scores at any time point. Conclusion: This trial did not demonstrate the superiority of intraoperative bone channeling in rotator cuff repair over standard rotator cuff repair at 24 months postoperatively. Healing rates, patient-reported function, and quality-of-life outcomes were similar between groups. Registration: NCT01877772 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

A splenic patients are an often overlooked group of immunocompromised patients who are at risk for serious infections. Overwhelming postsplenectomy sepsis (OPSI) is a well-characterized phenomenon that is typically caused [...], Background: Asplenic patients in general have poor knowledge about their condition. Patients are increasingly turning to the Internet for their health care information, therefore this is a resource that many asplenic patients will use. The aim of our study was to determine the quality of information on the Internet for asplenic patients. Methods: We identified websites by entering "splenectomy OR spleen removal" into 3 Internet search engines on July 28, 2008. The top 50 English-language websites from each search engine were included in our analysis. We evaluated the websites with our own 21-point content scale as well as 4 commonly used quality-assessment tools. All websites were analyzed independently by 2 reviewers. Correlations were made between the quality assessment instruments, content, readability and target audience. Results: We included 89 websites in the study. The mean content score percentage for all websites was 49% (95% confidence interval 44%-54%). The long-term risk of infection was mentioned in 84% of websites, and the need for vaccination was mentioned in 79%. The mean quality assessment tool score was 61%, and the mean reading grade level was 11. Conclusion: Whereas websites on average did not cover most of the information that asplenic patients should receive, the long-term risk of serious infection and the need for vaccination was consistently mentioned. Websites were inconsistent with respect to adhering to standards advocated by the quality assessment instruments we used, and the mean reading grade level was far above what is recommended for patient literature. Contexte : Les patients aspleniques connaissent en general mal leur etat. Les patients se tournent de plus en plus vers Internet pour trouver de l&apos;information sur les soins de sante et il s&apos;agit donc d&apos;une ressource que beaucoup de patients aspleniques utiliseront. Notre etude visait a determiner la qualite de l&apos;information qu&apos;offre Internet aux patients aspleniques. Methodes : Nous avons trouve des sites web en entrant les expressions << splenectomie OU ablation de la rate >> dans 3 moteurs de recherche sur Internet le 28 juillet 2008. Cette analyse a porte sur les 50 principaux sites web de langue anglaise trouves par chaque moteur de recherche. Nous avons evalue les sites web au moyen de notre propre echelle comportant 21 points, ainsi que de 4 outils d&apos;evaluation de la qualite d&apos;usage courant. Deux examinateurs ont analyse independamment tous les sites web. On a etabli des liens entre l&apos;instrument d&apos;evaluation de la qualite, le contenu, le niveau de lecture et le public cible. Resultats : L&apos;etude a porte sur 89 sites web. Le pourcentage du score moyen obtenu pour le contenu de tous les sites web s&apos;est etabli a 49 % (intervalle de confiance a 95 %, 44 % a 54 %). Le risque a long terme d&apos;infection a ete mentionne par 84 % des sites web et le besoin de vaccination a ete mentionne par 79 % des sites. Le score moyen produit par l&apos;outil d&apos;evaluation de la qualite s&apos;est etabli a 61 % et le niveau moyen de lecture, a secondaire 5. Conclusion : En moyenne, les sites web ne couvraient pas la majeure partie de l&apos;information que les patients aspleniques devraient recevoir, meme si l&apos;on mentionnait frequemment le risque a long terme d&apos;infection grave et le besoin de vaccination. Les sites web manquaient d&apos;uniformite en ce qui a trait a l&apos;observation des normes preconisees par les instruments d&apos;evaluation de la qualite que nous avons utilises et le niveau moyen de lecture depassait de loin celui que l&apos;on recommande dans les publications destinees aux patients.

Three main methods are currently used to perform a colorectal resection: the traditional 'open' technique via a laparotomy, the laparoscopic approach and a hybrid hand-assisted laparoscopic approach using a device [...], Background: Laparoscopic surgery may become the standard of care for the treatment of colorectal disease. Little is known regarding North American patterns of practice or the limiting factors and strategies for adoption among surgeons. Methods: We sent a 28-item questionnaire to all general surgeon members of the Royal College of Physicians and Surgeons of Canada. We derived descriptive and correlative information using [chi square], Wilcoxon rank sum and Student t tests and multivariate logistic regression. Results: The return rate was 55% (694/1266). A total of 67% (462/694; 95% confidence interval 63%-70%) of respondents perform colorectal surgery. Of these, 54% perform laparoscopic colorectal surgery. Multivariate logistic regression identified 5 factors related to performing laparoscopic colorectal surgery: fewer years in practice (p < 0.001), male sex (p = 0.015), practising in the province of Quebec (p = 0.005), university-hospital affiliation (p = 0.034) and minimally invasive surgery fellowship training (p = 0.023). Lack of adequate operating time and formal training were the main reasons cited by surgeons not offering laparoscopic colon resections. Most surgeons (67%) felt that site visits from a minimally invasive surgeon would represent the most effective training method for acquiring advanced laparoscopic skills. Conclusion: About half of Canadian general surgeons offer laparoscopic colorectal resections. Recent graduation, male sex, practice location, university-hospital affiliation and minimally invasive surgery training are significant predictors for offering a laparoscopic approach. Lack of operative time and formal training are the main barriers to adoption of the technique. Site visits by trained laparoscopic surgeons is the preferred method of acquiring advanced skills. Contexte : La chirurgie par laparoscopie est devenue la norme de soins pour le traitement des maladies colorectales. On ne connait guere les tendances de la pratique en Amerique du Nord ou les facteurs limiteurs et les strategies d'adoption chez les chirurgiens. Methodes : Nous avons envoye un questionnaire en 28 points a tous les chirurgiens generaux membres du College royal des medecins et chirurgiens du Canada. Nous avons derive l'information descriptive et correlative au moyen des tests [khi carre], de Wilcoxon et t de Student, ainsi que par regression logistique a variables multiples. Resultats : Le taux de reponse s'est etabli a 55% (694/1266). Au total, 67% (462/694; intervalle de confiance a 9%, 63% a 70%) des repondants pratiquent la chirurgie colorectale. De ce nombre, 54% pratiquent la chirurgie colorectale par laparoscopie. La regression logistique a variables multiples a degage 5 facteurs relies a la chirurgie colorectale par laparoscopie : moins d'annees de pratique (p < 0,001), sexe masculin (p = 0,015), pratique dans la province de Quebec (p = 0,005), affiliation a un hopital universitaire (p = 0,034) et fellowship en chirurgie a effraction minimale (p = 0,023). Le manque de temps suffisant pour operer et de formation structuree cons tituait la principale raison invoquee par les chirurgiens pour ne pas offrir la resection du colon par laparoscopie. La plupart des chirurgiens (67%) etaient d'avis que la methode de formation la plus efficace pour leur permettre d'acquerir des techniques avancees de laparoscopie consisterait en visites sur place d'un chirurgien pratiquant la chirurgie a effraction minimale. Conclusion : Environ la moitie des chirurgiens generaux canadiens offrent la resection colorectale par laparoscopie. Le diplome recent, le sexe masculin, le lieu de pratique, l'affiliation a un hopital universitaire et une formation en chirurgie a effraction minimale sont des predicteurs importants de l'approche laparoscopique. Le manque de temps pour operer et de formation structuree constitue le principal obstacle a l'adoption de la technique. Des visites sur place par des chirurgiens formes en laparoscopie constituent la methode preferee d'acquisition de techniques avancees.

Burnout is a growing concern, with significant negative consequences for physicians and patient care. Burnout is negatively associated with physician empathy, while resilience may be a protective factor against the development of burnout but few studies have examined all three constructs in the same cohort. Understanding the associations between these constructs could aid in the development of interventions for physicians experiencing burnout and improve the delivery of compassionate care. We conducted a cross-sectional survey to determine levels of burnout, empathy and resilience in a sample of academic physicians and investigate the relationships between these variables. Validated scales were administered online to measure burnout (Maslach Burnout Inventory – Human Services Survey, MBI-HSS), empathy (Jefferson Scale of Empathy – Physicians/Health Professions Version, JSE) and resilience (Connor-Davidson Resilience Scale, CD-RISC). Descriptive statistics, correlation coefficients, and group comparisons were examined. Eighty-three physicians completed the JSE and CD-RISC, while a subset of 49 physicians also completed the MBI-HSS. Response rates were 31.9% and 18.8%, respectively. High burnout was reported by 49% of the sample. Physicians with high burnout reported lower levels of resilience than those who were not burnt-out. No differences in levels of empathy were observed between these two groups. Older physicians (>45 years) reported higher resilience scores than younger physicians. Resilience and empathy were significantly positively correlated. The reported rate of physician burnout in this sample of academic physicians is concerning, with burnout associated with lower levels of resilience. Further research is required to explore the relationship between physician age and resilience, the impact of resilience-building interventions on burnout and empathy in physicians, and how modifying these variables influences the delivery of compassionate care for patients. [ABSTRACT FROM AUTHOR]