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Canadian general surgeons' opinions about clinical practice audit.

https://arctichealth.org/en/permalink/ahliterature115511
Source
Surgery. 2013 Jun;153(6):762-70
Publication Type
Article
Date
Jun-2013
Author
Iman Ghaderi
Amin Madani
Christopher J de Gara
Christopher M Schlachta
Author Affiliation
Department of Surgery, Division of General Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. iman.ghaderi@gmail.com
Source
Surgery. 2013 Jun;153(6):762-70
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Adult
Advisory Committees
Attitude of Health Personnel
Canada
Clinical Audit - methods - utilization
Clinical Competence - standards
Data Collection
Female
General Surgery - standards
Humans
Male
Middle Aged
Societies, Medical
Abstract
The objective of this study was to explore the opinions of Canadian surgeons about their knowledge regarding clinical practice audit (CPA), existing audit tools, experience with CPA, barriers to implementation, and concerns about consequences of CPA implementation.
A 20-question survey was distributed to members of the Canadian Association of General Surgeons.
Of the surveys distributed, 108 were completed, a response rate of 13.5%. The mean age of the participants was 44 years (SD, 12). Familiarity with common audit tools ranged from 4% to 28%, with 41% familiar with none and 44% having previously performed CPA. Most respondents believed that CPA should be mandatory (48%); that CPA is best done by self (34%); and that the Ministry of Health ought to pay for CPA (35%). Using a Likert scale, we found that a majority of respondents felt that CPA is effective in changing both clinical practice (73%) and patient outcomes (57%) and that barriers included time constraints (91%), cost (62%), resources (91%), and inadequate documentation (57%). A majority of respondents would participate in CPA if the data were reviewed by themselves (93%), their department (82%), the Royal College (51%), or provincial organizations (48%) as long as the data were not made available to the public (42%), the ministry of health (48%), or hospital administration (47%).
Canadian surgeons perceive usefulness in clinical audit but have limited knowledge about available audit tools and resources. The creation of a national auditing system combined with strategies for effective implementation of this system is the stepping-stone in this process.
PubMed ID
23499017 View in PubMed
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The cost of bariatric medical tourism on the Canadian healthcare system.

https://arctichealth.org/en/permalink/ahliterature104354
Source
Am J Surg. 2014 May;207(5):743-6; discussion 746-7
Publication Type
Article
Date
May-2014
Author
Caroline E Sheppard
Erica L W Lester
Shahzeer Karmali
Christopher J de Gara
Daniel W Birch
Author Affiliation
Centre for the Advancement of Minimally Invasive Surgery, Room No. 502 CSC, 10240 Kingsway Avenue, Royal Alexandra Hospital, Edmonton, Alberta T5H 3V9, Canada; University of Alberta, 2-590 Edmonton Clinic Health Academy, 11405-87 Avenue NW, Edmonton, Alberta T6G 1C9, Canada.
Source
Am J Surg. 2014 May;207(5):743-6; discussion 746-7
Date
May-2014
Language
English
Publication Type
Article
Keywords
Adult
Bariatric Surgery - economics
Canada
Female
Health Care Costs - statistics & numerical data
Humans
Male
Medical Tourism - economics
Middle Aged
Postoperative Care - economics
Postoperative Complications - economics - therapy
Abstract
Medical tourists are defined as individuals who intentionally travel from their home province/country to receive medical care. Minimal literature exists on the cost of postoperative care and complications for medical tourists. The costs associated with these patients were reviewed.
Between February 2009 and June 2013, 62 patients were determined to be medical tourists. Patients were included if their initial surgery was performed between January 2003 and June 2013. A chart review was performed to identify intervention costs sustained upon their return.
Conservatively, the costs of length of stay (n = 657, $1,433,673.00), operative procedures (n = 110, $148,924.30), investigations (n = 700, $214,499.06), blood work (n = 357, $19,656.90), and health professionals' time (n = 76, $17,414.87) were summated to the total cost of $1.8 million CAD.
The absolute denominator of patients who go abroad for bariatric surgery is unknown. Despite this, a substantial cost is incurred because of medical tourism. Future investigations will analyze the cost effectiveness of bariatric surgery conducted abroad compared with local treatment.
PubMed ID
24791638 View in PubMed
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Hands-free technique in the operating room: reduction in body fluid exposure and the value of a training video.

https://arctichealth.org/en/permalink/ahliterature149584
Source
Public Health Rep. 2009 Jul-Aug;124 Suppl 1:169-79
Publication Type
Article
Author
Bernadette Stringer
Ted Haines
Charles H Goldsmith
Jennifer Blythe
Ramon Berguer
Joel Andersen
Christopher J De Gara
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Source
Public Health Rep. 2009 Jul-Aug;124 Suppl 1:169-79
Language
English
Publication Type
Article
Keywords
Accidents, Occupational - prevention & control - statistics & numerical data
Blood-Borne Pathogens
Humans
Inservice Training - methods
Needlestick Injuries - epidemiology - prevention & control
Occupational Exposure - prevention & control
Ontario - epidemiology
Operating Rooms - manpower - methods - standards
Regression Analysis
Safety Management - methods
Video Recording
Abstract
This study sought to determine if (1) using a hands-free technique (HFT)--whereby no two surgical team members touch the same sharp item simultaneously--> or = 75% of the time reduced the rate of percutaneous injury, glove tear, and contamination (incidents); and (2) if a video-based intervention increased HFT use to > or = 75%, immediately and over time.
During three and four periods, in three intervention and three control hospitals, respectively, nurses recorded incidents, percentage of HFT use, and other information in 10,596 surgeries. The video was shown in intervention hospitals between Periods 1 and 2, and in control hospitals between Periods 3 and 4. HFT, considered used when > or = 75% passes were done hands-free, was practiced in 35% of all surgeries. We applied logistic regression to (1) estimate the rate reduction for incidents in surgeries when the HFT was used and not used, while adjusting for potential risk factors, and (2) estimate HFT use of about 75% and 100%, in intervention compared with control hospitals, in Period 2 compared with Period 1, and Period 3 compared with Period 2.
A total of 202 incidents (49 injuries, 125 glove tears, and 28 contaminations) were reported. Adjusted for differences in surgical type, length, emergency status, blood loss, time of day, and number of personnel present for > or = 75% of the surgery, the HFT-associated reduction in rate was 35%. An increase in use of HFT of > or = 75% was significantly greater in intervention hospitals, during the first post-intervention period, and was sustained five months later.
The use of HFT and the HFT video were both found to be effective.
Notes
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PubMed ID
19618819 View in PubMed
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Perceptions of conflict of interest: surgeons, internists, and learners compared.

https://arctichealth.org/en/permalink/ahliterature114678
Source
Am J Surg. 2013 May;205(5):541-5; discussion 545-6
Publication Type
Article
Date
May-2013
Author
Christopher J de Gara
Kim C Rennick
John Hanson
Author Affiliation
Department of Surgery, University of Alberta, 2-590 Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta, Canada T6G 1C9. cdegara@ualberta.ca
Source
Am J Surg. 2013 May;205(5):541-5; discussion 545-6
Date
May-2013
Language
English
Publication Type
Article
Keywords
Alberta
Attitude of Health Personnel
Bias (epidemiology)
Biomedical Research - ethics
Conflict of Interest
General Surgery
Humans
Internal Medicine
Physicians - psychology
Questionnaires
Research Support as Topic - ethics
Students, Medical - psychology
Abstract
Making a conflict of interest declaration is now mandatory at continuing medical education CME accredited events. However, these declarations tend to be largely perfunctory. This study sought to better understand physician perceptions surrounding conflict of interest.
The same PowerPoint (Microsoft, Canada) presentation (http://www.youtube.com/watch?v=mQSOvch7Yg0&feature=g-upl) was delivered at multiple University of Alberta and Royal College CME-accredited events to surgeons, internists, and learners. After each talk, the audience was invited to complete an anonymous, pretested, and standardized 5-point Likert scale (strongly disagree to strongly agree) questionnaire.
A total of 136 surveys were analyzed from 31 surgeons, 49 internists, and 56 learners. In response to the question regarding whether by simply making a declaration, the speaker had provided adequate proof of any conflicts of interest, 71% of surgeons thought so, whereas only 35% of internists and 39% of learners agreed or strongly agreed (P = .004). Further probing this theme, the audience was asked whether a speaker must declare fees or monies received from industry for consulting, speaking, and research support. Once again there was a variance of opinion, with only 43% of surgeons agreeing or strongly agreeing with this statement; yet, 80% of internists and 71% of learners felt that such a declaration was necessary (P = .013). On the topic of believability (a speaker declaration makes him or her and the presentation more credible), the 3 groups were less polarized: 50% of surgeons, 41% of internists, and 52% of learners (P = .2) felt that this was the case. Although two thirds of surgeons (68%) and learners (66%) and nearly all internists (84%) felt that industry-sponsored research was biased, these differences were not significant (P = .2).
Even when they are completely open and honest, conflict of interest declarations do not negate the biases inherent in a speaker's talk or research when it is industry sponsored. The larger issue is how best to manage these conflicts.
PubMed ID
23592160 View in PubMed
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