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FACTS survey: focused assessment with sonography in trauma use among Canadian residents training in general surgery.

https://arctichealth.org/en/permalink/ahliterature140138
Source
J Trauma. 2010 Oct;69(4):765-9
Publication Type
Article
Date
Oct-2010
Author
Luc Dubois
Ken Leslie
Neil Parry
Author Affiliation
Division of General Surgery, Department of Surgery, The Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada. ldubois@uwo.ca
Source
J Trauma. 2010 Oct;69(4):765-9
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Clinical Competence
Cross-Sectional Studies
Curriculum
Data Collection
Emergency Medicine - education
General Surgery - education
Humans
Internship and Residency
Interprofessional Relations
Radiology - education
Ultrasonography - methods
Wounds and Injuries - ultrasonography
Abstract
A survey of all Canadian residents training in general surgery was conducted to determine the prevalence and nature of focused assessment with sonography in trauma (FAST) training.
A cross-sectional survey of all 549 residents in 16 Canadian general surgery programs was administered using the Tailored Design Method between December 2008 and February 2009.
With a response rate of 58.5% (321 of 549), the prevalence of FAST training among Canadian residents was 21.2% (95% confidence interval: 17.2-25.2). The median number of practice and patient examinations completed was 5 (interquartile range [IQR]: 2-10.5) and 11.5 (IQR: 1.75-50), respectively. Only 38.8% of residents with training felt comfortable making treatment decisions based on their FAST examinations. Those residents who were comfortable had completed more practice and patient examinations (median, 12.5 vs. 4, p = 0.001 and 30 vs. 4.5, p = 0.001, respectively) and were less likely to have didactic only training (7.7% vs. 19.5%, p = 0.002). Most residents (80%) indicated that they would need 20 practice examinations or more (median, 30 examinations; IQR, 20-40) before they would feel comfortable. Residents with FAST training were more likely to be from a program that offered FAST training (54.5% vs. 10%, p = 0.001) and were less likely to perceive a turf war with other specialties over FAST use (29.9% vs. 48.2%, p = 0.007).
The situation with FAST training in Canada seems inadequate with few general surgery residents being trained, and of those trained, only a few are comfortable with the technique. If FAST skills are to be expected of future surgeons, initiatives must be put in place to address barriers and improve training opportunities.
PubMed ID
20938264 View in PubMed
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Impact of an outpatient appendectomy protocol on clinical outcomes and cost: a case-control study.

https://arctichealth.org/en/permalink/ahliterature140755
Source
J Am Coll Surg. 2010 Dec;211(6):731-7
Publication Type
Article
Date
Dec-2010
Author
Luc Dubois
Kelly N Vogt
Ward Davies
Christopher M Schlachta
Author Affiliation
Department of Surgery, Division of General Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada. ldubois@uwo.ca
Source
J Am Coll Surg. 2010 Dec;211(6):731-7
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adult
Aged
Ambulatory Care - economics - methods - standards
Ambulatory Surgical Procedures - economics - standards
Appendectomy - adverse effects - economics - methods - standards
Appendicitis - surgery
Canada
Case-Control Studies
Comorbidity
Emergencies
Female
Humans
Laparoscopy
Male
Middle Aged
Outcome Assessment (Health Care)
Patient Admission
Patient Discharge
Young Adult
Abstract
Although elective outpatient surgery is commonplace, surgeons remain hesitant to discharge patients the same day after emergent surgery. We created a formal protocol to select patients for early discharge after laparoscopic appendectomy for acute appendicitis, and we assessed its safety and potential cost savings.
We matched patients who were discharged early from the recovery room with similar patients from a control group on the basis of age ± 3 years, presence or absence of a comorbidity, laparoscopic procedure, and nonperforated appendicitis; we compared them to assess the impact of early discharge on morbidity, return visits to the emergency room, and total cost incurred by our institution.
During the first year of our protocol, 72 of 161 (45%) patients who presented with acute appendicitis and underwent appendectomy were discharged early, with a median post-operative length of stay of 4.7 hours. When compared with matched controls, patients discharged early had similar complication rates (4.3% early group vs 7.1%, p = 0.72) and number of postoperative visits to the emergency room (11.4% vs 11.4%, p = 0.8), but had a reduced median length of stay (4.7 vs 16.2 hours, p
Notes
Comment In: J Am Coll Surg. 2011 Jul;213(1):197; author reply 197-821700198
PubMed ID
20846883 View in PubMed
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Identification of patient-derived outcomes after aortic aneurysm repair.

https://arctichealth.org/en/permalink/ahliterature105202
Source
J Vasc Surg. 2014 Jun;59(6):1528-34
Publication Type
Article
Date
Jun-2014
Author
Luc Dubois
Teresa V Novick
Adam H Power
Guy DeRose
Thomas L Forbes
Author Affiliation
Division of Vascular Surgery, London Health Sciences Centre and Western University, London, Ontario, Canada. Electronic address: luc.dubois@lhsc.on.ca.
Source
J Vasc Surg. 2014 Jun;59(6):1528-34
Date
Jun-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - surgery
Blood Vessel Prosthesis Implantation - methods
Decision Making
Endovascular Procedures - methods
Female
Focus Groups
Follow-Up Studies
Humans
Incidence
Length of Stay - trends
Male
Middle Aged
Ontario - epidemiology
Patient Selection
Postoperative Complications - epidemiology
Prospective Studies
Risk Assessment - methods
Time Factors
Treatment Outcome
Abstract
Relatively few outcomes have been examined in randomized comparisons of endovascular and open aortic aneurysm repair, and no patient input was obtained in the selection of these outcomes. The aim of this study was to identify patient-derived, potentially novel outcomes that may be used to guide future clinical trials in aneurysm surgery.
Focus group interviews were conducted with patients who had undergone endovascular or open aortic aneurysm repair. The discussions were transcribed and the transcript was analyzed by two indexers using constant-comparison analysis and grounded theory to identify potentially novel, patient-derived outcomes. Other potential themes relating to the patients' experience and their decision-making were also sought.
Six focus groups were conducted (three with endovascular aneurysm repair patients and three with open aortic aneurysm repair patients), with a median of six participants, 2 to 12 months from surgery. Functional outcomes were most commonly mentioned and emphasized by patients. Recovery time and energy level were most frequently verbalized as important in the decision-making process between endovascular and open aneurysm repair. Other potential outcomes identified as important to patients included postoperative pain, time to walking normally, loss of appetite, extent and location of incisions, impact on cognition, being able to go home after surgery, and impact on caregivers. In addition to these outcomes, we identified three themes relating to the patient's experience: undervaluing or underappreciating the risk of death during surgery, differing informational needs and level of involvement in decision-making, and unrealistic patient expectations about the risks of and recovery after the procedure.
Functional outcomes emerged as most important during qualitative analysis of patients' experiences with aneurysm repair. Perceived differences in recovery time were identified as an important consideration for aneurysm patients in deciding between open and endovascular repair. More work needs to be done clarifying the concept of recovery and other related functional outcomes for the development of methods to assess and to evaluate these in prospective clinical trials.
PubMed ID
24447539 View in PubMed
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Role of Evidence-Based Reviews in Surgery in teaching critical appraisal skills and in journal clubs.

https://arctichealth.org/en/permalink/ahliterature108480
Source
Can J Surg. 2013 Aug;56(4):E98-102
Publication Type
Article
Date
Aug-2013
Author
Negar Ahmadi
Luc Dubois
Marg McKenzie
Carl J Brown
Anthony R MacLean
Robin S McLeod
Author Affiliation
Division of General Surgery, Zane Cohen Clinical Research Centre and Samuel Lunenfeld Research Institute, Mount Sinai Hospital Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.
Source
Can J Surg. 2013 Aug;56(4):E98-102
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Education, Medical, Graduate
Evidence-Based Medicine - education
General Surgery - education
Humans
Internship and Residency
Periodicals as Topic
Questionnaires
Abstract
Evidence-Based Reviews in Surgery (EBRS) is a program developed to teach critical appraisal skills to general surgeons and residents. The purpose of this study was to assess the use of EBRS by general surgery residents across Canada and to assess residents' opinions regarding EBRS and journal clubs.
We surveyed postgraduate year 2-5 residents from 15 general surgery programs. Data are presented as percentages and means.
A total of 231 residents (58%, mean 56% per program, range 0%-100%) responded: 172 (75%) residents indicated that they know about EBRS and that it is used in their programs. More than 75% of residents who use EBRS agreed or strongly agreed that the EBRS clinical and methodological articles and reviews are relevant. Only 55 residents (24%) indicated that they used EBRS online. Most residents (198 [86%]) attend journal clubs. The most common format is a mandatory meeting held at a special time every month with faculty members with epidemiological and clinical expertise. Residents stated that EBRS articles were used exclusively (13%) or in conjunction with other articles (57%) in their journal clubs. Most respondents (176 of 193 [91%]) stated that journal clubs are very or somewhat valuable to their education.
The EBRS program is widely used among general surgery residents across Canada. Although most residents who use EBRS rate it highly, a large proportion are unaware of EBRS online features. Thus, future efforts to increase awareness of EBRS online features and increase its accessibility are required.
Notes
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PubMed ID
23883511 View in PubMed
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The more the better?: the impact of surgeon and hospital volume on in-hospital mortality following colorectal resection.

https://arctichealth.org/en/permalink/ahliterature150733
Source
Ann Surg. 2009 Jun;249(6):954-9
Publication Type
Article
Date
Jun-2009
Author
Paul J Karanicolas
Luc Dubois
Patrick H D Colquhoun
Carol J Swallow
Stephen D Walter
Gordon H Guyatt
Author Affiliation
Department of Surgery, The University of Western Ontario, London, Canada. pjkarani@uwo.ca
Source
Ann Surg. 2009 Jun;249(6):954-9
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada - epidemiology
Colectomy - mortality - statistics & numerical data
Colonic Diseases - mortality - pathology - surgery
Female
Health Facility Size
Hospital Mortality
Hospitalization - statistics & numerical data
Humans
Male
Middle Aged
Risk factors
Surgical Procedures, Elective - mortality - statistics & numerical data
Workload
Abstract
To determine the in-hospital mortality rates for patients undergoing colorectal resection for malignant or benign conditions, and to identify risk factors for in-hospital death, particularly the relationships with surgeon and hospital volume.
Although there is strong evidence that complex cancer operations are best performed at specialized high-volume centers and by high-volume surgeons, the relationship between surgeon and hospital volume and perioperative outcomes is less well defined for more common procedures such as colorectal resections, particularly for benign diseases.
We obtained data from the Canadian Institute for Health Information Discharge Abstract Database on all adult patients who underwent colorectal resection between April 1, 2005 and March 31, 2006. We performed a logistic regression to identify variables associated with a higher likelihood of in-hospital death.
Twenty-one thousand seventy-four patients underwent colorectal resection, with the majority being elective (59.4%). Malignancy represented the most common indication for resection (56.8%), followed by diverticular disease (16.2%) and inflammatory bowel disease (7.1%). The overall in-hospital mortality rate among patients undergoing colorectal resection was 5.3%. Increased age (adjusted Odds Ratio [OR]: 1.97 per 10 years, P
PubMed ID
19474684 View in PubMed
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Determination of patient preference for location of elective abdominal aortic aneurysm surgery.

https://arctichealth.org/en/permalink/ahliterature114793
Source
Vasc Endovascular Surg. 2013 May;47(4):288-93
Publication Type
Article
Date
May-2013
Author
John H Landau
Teresa V Novick
Luc Dubois
Adam H Power
Jeremy R Harris
Guy Derose
Thomas L Forbes
Author Affiliation
Division of Vascular Surgery, London Health Sciences Centre & Western University, London, Ontario, Canada.
Source
Vasc Endovascular Surg. 2013 May;47(4):288-93
Date
May-2013
Language
English
Publication Type
Article
Keywords
Aged
Aortic Aneurysm, Abdominal - diagnosis - mortality - surgery
Catchment Area (Health)
Female
Health Care Surveys
Health Services Accessibility
Hospitals, High-Volume
Hospitals, Low-Volume
Humans
Male
Ontario
Outcome and Process Assessment (Health Care)
Patient Preference
Quality Indicators, Health Care
Questionnaires
Risk assessment
Risk factors
Surgical Procedures, Elective
Treatment Outcome
Vascular Surgical Procedures - adverse effects - mortality
Abstract
Aneurysm repair is centralized in higher volume centers resulting in reduced mortality, with longer travel distances. The purpose of this study is to explore patients' preference between local care versus longer distances and lower mortality rates.
Patients with abdominal aortic aneurysm (AAA) measuring 4 to 5 cm and living at least a 1-hour drive from our hospital were asked to assume it had grown to 5.5 cm, and repair was recommended with a mortality risk of 2%. The level of additional risk they would accept to undergo surgery locally was determined.
A total of 67 patients were surveyed. If mortality risk was equivalent at the local and regional hospitals, 44% preferred care at our tertiary center, while 56% preferred surgery locally. If perioperative mortality was increased at the local hospital, 9% preferred local surgery.
The vast majority of patients with AAA will accept longer travel distances for care as long as it results in a reduction in perioperative mortality.
PubMed ID
23579366 View in PubMed
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6 records – page 1 of 1.