Canadian Journal of Surgery最新文献

{"title":"Colorectal surgeon physical pain and conditioning: a national survey.","authors":"Garrett Johnson, Haven Roy, Sandra Webber, Farhana Shariff, Ramzi Helewa, David Hochman, Jason Park, Eric Hyun","doi":"10.1503/cjs.007724","DOIUrl":"10.1503/cjs.007724","url":null,"abstract":"<p><strong>Background: </strong>Workplace injuries are increasingly recognized as a substantial detriment to surgeon longevity and productivity. Limited data exist on pain and injury prevalence among rectal surgeons. In this epidemiologic study, we aimed to estimate the prevalence of physical discomfort among rectal surgeons in Canada and identify potential causative factors.</p><p><strong>Methods: </strong>We distributed a web-based survey to rectal surgeons in Canada between January and October 2022. We included colorectal surgeons, surgical oncologists, and colorectal surgery fellows associated with Canadian university hospitals.</p><p><strong>Results: </strong>Of the 72 surgeons we contacted, 48 participated (67%). More than 98% reported experiencing physical discomfort or pain during rectal surgery, with more than half experiencing these symptoms weekly. Neck, shoulders, and back were common pain or discomfort locations, whether surgeons were performing open surgery or using a minimally invasive platform. Laparoscopic equipment, headlight, and pelvic retractor use were the most common causes. Many surgeons (54%) sought professional treatment and employed risk-reducing strategies such as intraoperative stretching (48%) or after-work strength training exercises (52%). Satisfaction with pain levels during surgery was uncommon (40%). Multivariable analysis showed advancing age (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.02-1.23) and larger percentage of minimally invasive surgeries (OR 2.61, 95% CI 1.28-5.33) as significant predictors of increased discomfort. After-work exercise participation was protective in both open (OR 0.14, 95% CI 0.02-0.95) and minimally invasive surgeries (OR 0.60, 95% CI 0.37-0.98).</p><p><strong>Conclusion: </strong>Rectal surgeons in Canada commonly experience pain and injury during surgery, underscoring the need for improved safety measures to preserve their physical health and career longevity.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 1","pages":"E64-E70"},"PeriodicalIF":2.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11818781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of the Canadian Orthopaedic Surgery Medical Education Course (COSMEC): a virtual curriculum to enhance medical student learning.","authors":"Anser Daud, Tyler M Hauer, Kalter Hali, Noah Carr-Pries, Jesse I Wolfstadt, Peter Ferguson","doi":"10.1503/cjs.014723","DOIUrl":"10.1503/cjs.014723","url":null,"abstract":"<p><strong>Background: </strong>Studies have highlighted inadequate exposure to musculoskeletal education and orthopedic surgery in mandatory medical school curricula; thus, the Canadian Orthopaedic Surgery Medical Education Course (COSMEC) was designed to enhance medical education around orthopedic surgery and common musculoskeletal presentations encountered in primary care. We sought to explore the effectiveness of COSMEC in preparing medical students for clinical training and future practice.</p><p><strong>Methods: </strong>Canadian and international medical students were invited to participate in COSMEC, a 12-week virtual course led by orthopedic faculty and senior residents. Teaching objectives were guided by the musculoskeletal objectives of the Medical Council of Canada Qualifying Examination and expert opinion. We administered pre- and postcourse surveys to assess outcomes related to participant knowledge, confidence, and interest in orthopedic surgery.</p><p><strong>Results: </strong>A total of 133 medical students registered and completed COSMEC. Of these, we received 84 paired pre- and postcourse surveys. Knowledge scores improved from 7.9 (standard deviation [SD] 2.6) to 9.7 (SD 2.0) out of 14 (<i>p</i> < 0.001). There were significant improvements in participant-reported confidence in performing a history and physical examination, understanding the basic components of fracture management, managing bone and joint emergencies, and describing fracture radiographs (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Overall, COSMEC enhanced knowledge and confidence in orthopedic and musculoskeletal topics and is an effective extracurricular learning resource for medical students. It can help prepare medical students for future training and practice involving orthopedic and musculoskeletal patient presentations.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 1","pages":"E55-E61"},"PeriodicalIF":2.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11818783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IA et médecine — un mariage incontournable, mais encore imparfait.","authors":"Edward J Harvey, Chad G Ball","doi":"10.1503/cjs.001025","DOIUrl":"10.1503/cjs.001025","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 1","pages":"E71-E72"},"PeriodicalIF":2.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11818784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The acceptance of robots in the orthopedic joint replacement operating room.","authors":"Lauren Kelenc, Daryl Stephenson, Dianne Bryant, Brent Lanting","doi":"10.1503/cjs.016523","DOIUrl":"10.1503/cjs.016523","url":null,"abstract":"<p><strong>Background: </strong>Robotic surgery has seen substantial growth over the years and continues to show promise, with recent implementation into orthopedic surgery. There is limited literature available on patient attitudes and comfort level with robotic compared with conventional surgery. We aimed to develop an understanding of patient views on robot-assisted knee replacement to help the development of patient education materials and facilitate successful implementation.</p><p><strong>Methods: </strong>A qualitative, descriptive methodology was used. Included participants were those who had undergone total knee replacement in the last 5 years. Participants completed an online semistructured interview assessing their past experiences and their fears and assumptions about robotic surgery. An inductive thematic analysis was completed to organize and present the major themes.</p><p><strong>Results: </strong>Four overarching themes described the areas patients focused on: advancements in surgery, perception of robotic surgery and surgeons, reliability, and patient education materials. Major subthemes included the proven reliability of robots, safety fears, and efficacy. Some participants' fear centred around robot autonomy. Greater comfort with the use of robots would occur if patients were given information about the role of the robot before surgery.</p><p><strong>Conclusion: </strong>Patient education materials can help alleviate fears and prevent misperceptions about robot-assisted knee replacement. Materials should include themes of surgical advancements and how surgeons interact with these advancements, level of robot autonomy, and the reliability and safety of the robot.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 1","pages":"E32-E40"},"PeriodicalIF":2.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender trends in orthopedic surgical residency programs in Canada over 20 years.","authors":"Abigail Frazer, Silvio Ndoja, Holly S Howe, Supriya Singh","doi":"10.1503/cjs.012023","DOIUrl":"10.1503/cjs.012023","url":null,"abstract":"<p><strong>Background: </strong>Gender disparities exist in several surgical specialties, particularly in orthopedic surgery. The purpose of this study was to determine the current trends in gender diversity among orthopedic surgical residents in Canada over the last 20 years.</p><p><strong>Methods: </strong>We analyzed gender distribution data for orthopedic trainees from the Canadian Resident Matching Service (CaRMS) for 2013-2022 and the Canadian Post-MD Education Registry for 2000-2022 using linear and quadratic regressions.</p><p><strong>Results: </strong>More male (4.7%) than female medical students (1.9%) applied to an orthopedics program (<i>p</i> < 0.001). The proportion of male applicants entering CaRMS who applied to orthopedics followed a quadratic (U-shaped) distribution over time (<i>p</i> = 0.01). The proportion of female applicants remained unchanged from 2013 to 2022 (<i>p</i> > 0.9). However, for matching results, among the applicants who applied to orthopedic surgery, there was no gender effect (men 56.1% matched, women 50.3% matched; <i>p</i> = 0.3). The proportion of residency spots offered to female applicants remained at around 30%, without significant changes over time (<i>p</i> = 0.1). The number of female orthopedic graduates increased linearly from 2000 to 2021 (<i>p</i> < 0.001), projected to reach gender equalization (at 50%) by 2060. Female residents experienced higher attrition in residency (3.4%) than male residents (2.1%; <i>p</i> = 0.05), and this gender difference is decreasing over time (<i>p</i> = 0.03).</p><p><strong>Conclusion: </strong>Over 2 decades, women have shown consistently lower rates of application to orthopedic surgery programs than their male colleagues. Women who matched experienced higher attrition rates than men, although this appears to be improving over time.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 1","pages":"E41-E47"},"PeriodicalIF":2.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives surrounding robotic total hip arthroplasty: a cross-sectional analysis using natural language processing.","authors":"Jordan J Levett, Lior M Elkaim, David J Zukor, Olga L Huk, John Antoniou","doi":"10.1503/cjs.010423","DOIUrl":"10.1503/cjs.010423","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Robotic technology has been used in total hip arthroplasty (THA) for several years. Despite the advances in this field, perspectives surrounding robotic THA are not fully understood. This study aimed to characterize the landscape of robotic THA on social media.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Twitter application programming interface was queried from inception to October 2022 for keywords related to THA and robotics. Posts and accounts were extracted and classified using thematic labels. Sentiment analysis was performed on the extracted tweets.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;After removal of duplicate posts and illegitimate accounts, a total of 742 tweets from 741 accounts were retrieved. Most posts pertained to raising awareness about robotic THA (&lt;i&gt;n&lt;/i&gt; = 340, 45.8%), advertisements for THA robots (&lt;i&gt;n&lt;/i&gt; = 204, 27.5%), and personal experiences (&lt;i&gt;n&lt;/i&gt; = 138, 18.6%). Research was discussed in 7.0% (&lt;i&gt;n&lt;/i&gt; = 52) of posts. Most accounts belonged to patients or caregivers (&lt;i&gt;n&lt;/i&gt; = 177, 23.9%), followed by medical centres (&lt;i&gt;n&lt;/i&gt; = 175, 23.6%), news outlets (&lt;i&gt;n&lt;/i&gt; = 158, 21.3%), and physicians or researchers (&lt;i&gt;n&lt;/i&gt; = 101, 13.6%). Most posts discussing personal experience were positive (&lt;i&gt;n&lt;/i&gt; = 70, 50.7%) or neutral (&lt;i&gt;n&lt;/i&gt; = 39, 28.2%). Presence of media (β = 3.3, 95% confidence interval [CI] 1.5 to 5.1) and tagging (β = 2.1, 95% CI 0.3 to 2.8) positively affected user engagement, whereas the presence of a link decreased tweet engagement count by 2.8 (95% CI -5.4 to -0.2).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Topics about robotic THA were discussed in a positive tone on Twitter (rebranded to X in 2023). Posts about raising awareness and advertisements for robotic THA were most prevalent, while research-related posts were limited. Orthopedic surgeons can leverage social media to better understand patient perspectives and glean insight from the robotic surgery industry.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Contexte: &lt;/strong&gt;La robotique est utilisée depuis plusieurs années pour l'arthroplastie totale de la hanche (ATH). Malgré les progrès réalisés dans ce domaine, on connaît encore mal l'opinion qu'elle suscite. La présente étude visait à dresser un tableau de l'ATH robotisée telle qu'on l'aborde sur les réseaux sociaux. MÉTHODES: L'interface de programmation d'application de Twitter a été analysée depuis sa création et jusqu'à octobre 2022 à partir de mots clés reliés à l'ATH et à la robotique. Les messages et les comptes ont été extraits et classés par thèmes et une analyse des sentiments a été effectuée à partir de ces messages. RÉSULTATS: Après élimination des doublons et des faux comptes, nous avons retenu en tout 742 messages provenant de 741 comptes. La plupart visaient à faire connaître l'ATH assistée par robot (&lt;i&gt;n&lt;/i&gt; = 340, 45,8 %), faisaient la publicité pour des robots d'ATH (&lt;i&gt;n&lt;/i&gt; = 204, 27,5 %) et relataient des expériences personnelles (&lt;i&gt;n&lt;/i&gt; = 138, 18,6 %). La recherche était abordée dans 7","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 1","pages":"E10-E16"},"PeriodicalIF":2.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening Criteria Evaluation for Expansion in Pulmonary Neoplasias (SCREEN) II.","authors":"Bright Huo, Katerina-Maria Kontouli, Daria Manos, Zhaolin Xu, Samuel Chun, John Fris, Alison M R Wallace, Daniel G French","doi":"10.1503/cjs.015223","DOIUrl":"10.1503/cjs.015223","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There is a need to expand eligibility criteria for lung cancer screening beyond age and smoking history. In this study, we sought to assess whether light-or-never-smokers and heavy smokers differ in molecular and immunologic markers based on conventional lung cancer screening criteria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective review of lung cancer cases from 2005 to 2018 at a tertiary Canadian institution. We used multivariable logistic regression to compare the rate of molecular mutations (&lt;i&gt;KRAS&lt;/i&gt;, &lt;i&gt;EGFR&lt;/i&gt;, &lt;i&gt;BRAF&lt;/i&gt;, &lt;i&gt;PIK3CA&lt;/i&gt;, &lt;i&gt;ALK&lt;/i&gt;, and PD-L1 [&lt; 1%, 1%-49%, ≥ 50%]) and survival between light-or-never-smokers and heavy smokers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included 1156 patients with lung cancer. Overall, 46.4% (National Lung Screening Trial [NLST], &lt;i&gt;n&lt;/i&gt; = 536) and 63.3% (Nederlands-Leuvens Long-kanker Screenings Onderzoek [NELSON], &lt;i&gt;n&lt;/i&gt; = 732) of the patients were heavy smokers. Using NELSON criteria, screen-ineligible light-or-never-smokers were more frequently from areas at high risk for radon exposure (&lt;i&gt;n&lt;/i&gt; = 175 [41.3%]) than screen-eligible heavy smokers (&lt;i&gt;n&lt;/i&gt; = 285 [38.9%]). Light-or-never-smokers were more likely to be &lt;i&gt;EGFR&lt;/i&gt;-positive in both NLST (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.21-1.37; &lt;i&gt;p&lt;/i&gt; = 0.008] and NELSON (OR 0.79, 95% CI 0.28-1.31; &lt;i&gt;p&lt;/i&gt; = 0.002) models. Female light-or-never-smokers were more likely than male light-or-never-smokers to be &lt;i&gt;EGFR&lt;/i&gt;-positive in NELSON (OR 0.59, 95% CI 0.06-1.12; &lt;i&gt;p&lt;/i&gt; = 0.03] but not NLST (OR 0.51, 95% CI 0.02-1.05; &lt;i&gt;p&lt;/i&gt; = 0.06) models. Light-or-never-smokers were more often &lt;i&gt;PIK3CA&lt;/i&gt;-positive using NLST (OR 1.33, 95% CI 0.54-2.13; &lt;i&gt;p&lt;/i&gt; = 0.001) and NELSON (OR 1.19, 95% CI 0.49-1.90; &lt;i&gt;p&lt;/i&gt; = 0.001) models. Light-or-never-smokers in the NELSON model were at higher risk of death.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Screen-ineligible light-or-never-smokers had a higher rate of &lt;i&gt;EGFR-&lt;/i&gt;and &lt;i&gt;PIK3CA&lt;/i&gt;-positive lung cancers than screen-eligible heavy smokers when defined using trial-based lung cancer screening eligibility criteria. Molecular profiling, particularly where targeted therapy is available, should be considered in future studies establishing criteria for lung cancer screening.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Contexte: &lt;/strong&gt;Il faut élargir les critères d'admissibilité au dépistage du cancer du poumon au-delà de l'âge et des antécédents tabagiques. Dans cette étude, nous avons voulu vérifier s'il y a des différences entre les personnes dont le tabagisme est léger, voire nul (groupe 1) et celles qui fument beaucoup (groupe 2) au plan des marqueurs moléculaires et immunologiques selon les critères classiques de dépistage du cancer du poumon. MÉTHODES: Nous avons procédé à une revue rétrospective des cas de cancer du poumon de 2005 à 2018 dans un établissement de soins tertiaires canadien. Nous avons utilisé la régression logistique multivariée pour comparer ","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 1","pages":"E1-E9"},"PeriodicalIF":2.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rurality predisposes departure from gold-standard care, leading to delayed or accelerated access to surgery: insights from a scoping review.","authors":"Alisha Ebrahim, Sarthak Sinha, Ifeoluwa Adedipe, Abeer Ahmad, Madison Amyotte, Lucy Yang, Omar Elsewify, Sukhmeet S Sachal, Frankie O G Fraulin, Vincent A Gabriel, Grace Perez, Aaron Johnston","doi":"10.1503/cjs.000124","DOIUrl":"10.1503/cjs.000124","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Because tertiary centres are generally situated at urban sites, it is unclear whether patients in rural areas have the same access to surgical services that patients in urban areas do. We sought to map the North American evidence landscape of how rurality affects access to medically indicated surgeries and identify system-, patient-, and provider-level barriers that preclude urban-comparable care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We carried out a systematic search adhering to PRISMA for Scoping Reviews methodology across PubMed, MEDLINE, Scopus, and Web of Science, encompassing literature from the last 26 years (January 2023). Search terms included \"rural population,\" \"health care access,\" \"surgical procedures,\" and \"health disparities.\" We synthesized our findings using a narrative approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 13 897 identified studies, we included 71 publications, spanning a wide spectrum of surgical disciplines. Of these, 83% reported diminished and 17% reported accelerated access to surgery, and 30% reported an interaction between rurality with other social determinants of health, particularly age, sex and gender, and race and ethnicity. Of the studies that reported diminished access, top cited reasons included primary and specialist provider density, differences in patients' socioeconomic profiles, and provision of comparable counselling during surgical decisionmaking. Strikingly, a key driver of enhanced surgical access was an absence of specialized medical interventions leading to an overreliance on surgical alternatives.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Whether surgical access was diminished or accelerated, the net impact of rurality was a deviation from guideline-concordant care. A key implication of these findings is that reliance on surgical wait times alone can skew perception of surgical access, advocating for adoption of integrated quality-of-care metrics that better reflect access to comprehensive medical and surgical treatment programs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Contexte: &lt;/strong&gt;Étant donné que les centres de soins tertiaires se trouvent généralement en milieu urbain, on peut se demander si l'accès aux services chirurgicaux est le même en région rurale qu'en milieu urbain. Nous avons voulu cartographier, preuve à l'appui, l'impact de la ruralité sur l'accès à des chirurgies médicalement indiquées en Amérique du Nord et identifier les obstacles, propres au système, à la patientèle et aux équipes soignantes, qui nuisent à la prestation des soins équivalents à ceux des milieux urbains. MÉTHODES: Nous avons procédé à une interrogation systématique (conforme à la Norme de réalisation de revue systématique de la littérature PRISMA) des bases de données PubMed, MEDLINE, Scopus et Web of Science regroupant la littérature des 26 dernières années (janvier 2023). Les mots clés de langue anglaise utilisés incluaient : « rural population », « health care access », « surgical procedures » et « health dispa","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 1","pages":"E17-E31"},"PeriodicalIF":2.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analyzing the temporal trends of kidney transplantation surgeries and their impact on warm and cold ischemia time in a Canadian setting.","authors":"Ali Dergham, Luke Witherspoon, Joseph Y Nashed, Thomas Skinner, Liam Power, John Mahoney, Brian Blew, Jeffrey T Warren","doi":"10.1503/cjs.013422","DOIUrl":"10.1503/cjs.013422","url":null,"abstract":"<p><strong>Background: </strong>The effect of weekend admission and surgery on patient morbidity and mortality has been studied in many settings and has been shown to lead to worse outcomes. Several studies have sought to determine whether there is a weekend effect in kidney transplantation specifically, but a clear effect on outcomes and graft survival has not been established.</p><p><strong>Methods: </strong>We analyzed data from all deceased-donor organ procurements and cadaveric kidney transplants occurring during the 5-year period between Apr. 1, 2013, and Dec. 31, 2017, included in the database of the Trillium Gift of Life Network, Ontario's organ and tissue donation agency.</p><p><strong>Results: </strong>A total of 1116 deceased donor nephrectomies (DNs) and 1858 recipient procedures were performed in Ontario during the study period. The overall rate of after-hours DNs on weekdays was significantly greater than during working hours (23.1/30 d v. 15.4/30 d, <i>p</i> < 0.001). Donations after neurological determination of death were more frequent during weekday working hours (22.8/30 d) than after hours on weekdays (17.3/30 d, <i>p</i> < 0.001) or weekends (16.3/30 d, <i>p</i> < 0.001), whereas donations after cardiac death were significantly more frequent after hours on weekdays than during working hours (10.3/30 d v. 7.7/30 d, <i>p</i> = 0.021). On weekdays, mean warm ischemia time (WIT) was significantly longer after hours than during working hours (40.75 ± 12.26 min v. 38.52 ± 11.92 min, <i>p</i> = 0.017). Similarly, mean WIT was longer after hours than during working hours on weekends (40.23 ± 12.48 min v. 38.59 ± 11.91 min, <i>p</i> = 0.015).</p><p><strong>Conclusion: </strong>Kidney transplantations occurred more frequently after hours and were associated with increased WIT. Further study is needed across multiple Canadian centres to better understand the temporal patterns of kidney transplantation and implications for patients, providers, and health care systems.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"67 6","pages":"E406-E415"},"PeriodicalIF":2.2,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La contribution des militaires au paysage chirurgical canadien.","authors":"Chad G Ball, Edward J Harvey","doi":"10.1503/cjs.015224","DOIUrl":"10.1503/cjs.015224","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"67 6","pages":"E419"},"PeriodicalIF":2.2,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}