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Analysis of administrative data finds endoscopist quality measures associated with postcolonoscopy colorectal cancer.

https://arctichealth.org/en/permalink/ahliterature140652
Source
Gastroenterology. 2011 Jan;140(1):65-72
Publication Type
Article
Date
Jan-2011
Author
Nancy N Baxter
Rinku Sutradhar
Shawn S Forbes
Lawrence F Paszat
Refik Saskin
Linda Rabeneck
Author Affiliation
Department of Surgery and Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. baxtern@smh.toronto.on.ca
Source
Gastroenterology. 2011 Jan;140(1):65-72
Date
Jan-2011
Language
English
Publication Type
Article
Keywords
Adenoma - diagnosis
Adult
Aged
Aged, 80 and over
Clinical Competence
Colonoscopy - education
Colorectal Neoplasms - diagnosis
Early Detection of Cancer - standards
Female
Humans
Male
Middle Aged
Ontario
Quality Control
Young Adult
Abstract
Most quality indicators for colonoscopy measure processes; little is known about their relationship to patient outcomes. We investigated whether characteristics of endoscopists, determined from administrative data, are associated with development of postcolonoscopy colorectal cancer (PCCRC).
We identified individuals diagnosed with colorectal cancer in Ontario from 2000 to 2005 using the Ontario Cancer Registry. We determined performance of colonoscopy using Ontario Health Insurance Plan data. Patients who had complete colonoscopies 7 to 36 months before diagnosis were defined as having a PCCRC. Patients who had complete colonoscopies within 6 months of diagnosis had detected cancers. We determined if endoscopist factors (volume, polypectomy and completion rate, specialization, and setting) were associated with PCCRC using logistic regression, controlling for potential covariates.
In the study, 14,064 patients had a colonoscopy examination within 36 months of diagnosis; 584 (6.8%) with distal and 676 (12.4%) with proximal tumors had PCCRC. The endoscopist's specialty (nongastroenterologist/nongeneral surgeon) and setting (non-hospital-based colonoscopy) were associated with PCCRC. Those who underwent colonoscopy by an endoscopist with a high completion rate were less likely to have a PCCRC (distal: odds ratio [OR], 0.73; 95% confidence interval [CI], 0.54-0.97; P = .03; proximal: OR, 0.72; 95% CI, 0.53-0.97; P = .002). Patients with proximal cancers undergoing colonoscopy by endoscopists who performed polypectomies at high rates had a lower risk of PCCRC (OR, 0.61; 95% CI, 0.42-0.89; P
Notes
Comment In: Gastroenterology. 2011 Jan;140(1):19-2121110966
PubMed ID
20854818 View in PubMed
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Long-term survival in young adults with colorectal cancer: a population-based study.

https://arctichealth.org/en/permalink/ahliterature142826
Source
Dis Colon Rectum. 2010 Jul;53(7):973-8
Publication Type
Article
Date
Jul-2010
Author
Shawn S Forbes
Rinku Sutradhar
Lawrence F Paszat
Linda Rabeneck
David R Urbach
Nancy N Baxter
Author Affiliation
Department of Surgery, University of Toronto, Toronto, Ontario, Canada. shawn.forbes@utoronto.ca
Source
Dis Colon Rectum. 2010 Jul;53(7):973-8
Date
Jul-2010
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Colorectal Neoplasms - mortality
Female
Follow-Up Studies
Humans
Male
Ontario - epidemiology
Population Surveillance - methods
Retrospective Studies
Survival Rate - trends
Time Factors
Young Adult
Abstract
This study compares the long-term survival of young adults with colorectal cancer who lived a minimum of 5 years after diagnosis with a cancer-free control population.
A population-based study was conducted using cancer registry and administrative data. Persons aged 20 to 44 years in whom colorectal cancer was diagnosed between 1992 and 1999 and who lived at least 5 years after diagnosis were identified using the Ontario Cancer Registry. Patients with colorectal cancer were matched 1:5 to randomly selected controls (who were cancer free at the corresponding date of diagnosis) by use of the Registered Persons Database of Ontario based on age, sex, and geographic location. Time-to-death was compared between patients with colorectal cancer and controls by use of Kaplan-Meier estimates and Cox proportional hazard regression.
Nine hundred seventeen young adults with colorectal cancer who lived at least 5 years after diagnosis and 4585 controls were identified. The median follow-up after achieving 5-year survivor status was 6.2 years; 9.5% (87) of patients with colorectal cancer died compared with 1.2% (56) of controls (P
PubMed ID
20551747 View in PubMed
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Surgical site infection prevention: a survey to identify the gap between evidence and practice in University of Toronto teaching hospitals.

https://arctichealth.org/en/permalink/ahliterature124150
Source
Can J Surg. 2012 Aug;55(4):233-8
Publication Type
Article
Date
Aug-2012
Author
Cagla Eskicioglu
Anna R Gagliardi
Darlene S Fenech
Shawn S Forbes
Marg McKenzie
Robin S McLeod
Avery B Nathens
Author Affiliation
Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Ontario.
Source
Can J Surg. 2012 Aug;55(4):233-8
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Adult
Antibiotic Prophylaxis - statistics & numerical data
Cross Infection - epidemiology - prevention & control
Cross-Sectional Studies
Evidence-Based Medicine
Female
General Surgery - standards - trends
Hospitals, Teaching
Hospitals, University
Humans
Incidence
Infection Control - organization & administration
Internship and Residency
Male
Medical Staff, Hospital
Middle Aged
Needs Assessment
Ontario
Outcome Assessment (Health Care)
Physician's Practice Patterns
Questionnaires
Surgical Wound Infection - epidemiology - prevention & control
Abstract
A gap exists between the best evidence and practice with regards to surgical site infection (SSI) prevention. Awareness of evidence is the first step in knowledge translation.
A web-based survey was distributed to 59 general surgeons and 68 residents at University of Toronto teaching hospitals. Five domains pertaining to SSI prevention with questions addressing knowledge of prevention strategies, efficacy of antibiotics, strategies for changing practice and barriers to implementation of SSI prevention strategies were investigated.
Seventy-six individuals (60%) responded. More than 90% of respondents stated there was evidence for antibiotic prophylaxis and perioperative normothermia and reported use of these strategies. There was a discrepancy in the perceived evidence for and the self-reported use of perioperative hyperoxia, omission of hair removal and bowel preparation. Eighty-three percent of respondents felt that consulting published guidelines is important in making decisions regarding antibiotics. There was also a discrepancy between what respondents felt were important strategies to ensure timely administration of antibiotics and what strategies were in place. Checklists, standardized orders, protocols and formal surveillance programs were rated most highly by 75%-90% of respondents, but less than 50% stated that these strategies were in place at their institutions.
Broad-reaching initiatives that increase surgeon and trainee awareness and implementation of multifaceted hospital strategies that engage residents and attending surgeons are needed to change practice.
Notes
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PubMed ID
22617541 View in PubMed
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Undergraduate surgical training: variations in program objectives and curriculum implementation across Canada.

https://arctichealth.org/en/permalink/ahliterature170351
Source
Can J Surg. 2006 Feb;49(1):46-50
Publication Type
Article
Date
Feb-2006
Author
Shawn S Forbes
Peter G Fitzgerald
Daniel W Birch
Author Affiliation
Department of Surgery, McMaster University, Hamilton, Ont.
Source
Can J Surg. 2006 Feb;49(1):46-50
Date
Feb-2006
Language
English
Publication Type
Article
Keywords
Canada
Curriculum
Education, Medical, Undergraduate - organization & administration
General Surgery - education
Humans
Organizational Objectives
Program Evaluation - trends
Questionnaires
Abstract
Although nationally recognized learning objectives for undergraduate surgical education exist, the extent to which Canadian medical schools follow these guidelines has never been established.
We distributed a survey to all program directors and clinical-teaching-unit coordinators for undergraduate surgery at Canada's 16 medical schools, and subsequently assessed the perceived emphasis placed on learning objectives and student performance, and the impact of instructional tools and teaching locations.
Program directors in 15 medical schools responded to the survey. We identified a wide variation in the emphasis placed on basic learning objectives as well as specialty specific learning objectives. The length of rotations, methods of instruction and tools used to grade student performance also varied widely.
Our findings suggest significant variation in the design and implementation of undergraduate surgical education in Canada. This study may serve as a basis for reassessing learning objectives in Canadian undergraduate surgical education.
Notes
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Comment In: Can J Surg. 2010 Feb;53(1):E5-620100403
PubMed ID
16524143 View in PubMed
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