Canadian Journal of Surgery最新文献

Background: Wellness research has expanded in surgery owing to the high prevalence of burnout. In this scoping review, we aim to identify trends of wellness interventions for surgeons and surgical trainees.

Methods: We identified studies on wellness interventions across surgical specialties. We categorized interventions based on the targeted wellness domain, including physical, social, emotional, intellectual, and occupational domains.

Results: We included 49 studies in the final analysis. Most focused on resident wellness (n = 40) and were categorized as an individual-level intervention (n = 21). General surgery was represented in most studies (n = 24). Interventions focused on ergonomics, mindfulness, stress reduction, work hours, and wellness programs. Since 2015, there has been a shift in the wellness domains addressed from physical and occupational, to mostly emotional.

Conclusion: The prevalence of individual-level interventions targeting emotional wellness reflects a belief that surgeons are responsible for their own wellness. Studies to date have largely focused on surgical trainees, with a dearth of research on measures to improve staff surgeon wellness. Methodologically sound intervention studies with objective outcome measures are lacking and needed to facilitate a culture of shared organizational responsibility for surgeon well-being.

Background: Delivering trauma care in Nunavik is challenging. Despite the benefits of trauma registries, no routine data collection captures data from Nunavik patients in Quebec's provincial database. We sought to compare trauma epidemiology from data collected on site in Nunavik with data from a governmental registry at a tertiary centre, hypothesizing sufficient cohort differences to justify a dedicated registry.

Methods: We conducted a retrospective review of 2 cohorts (2015 to 2019). The first cohort included patients at Kuujjuaq's Centre de santé Tulattavik de l'Ungava or Puvirnituq's Centre de santé Inuulitisivik (the Nunavik cohort) and the second cohort included patients admitted to the provincial referral centre for the Nunavimmiut at the Montreal General Hospital (MGH). Nunavik data were collected through chart review, while MGH data were obtained from the McGill University Health Centre Trauma Registry. We analyzed patient demographics, injury mechanisms, transfer characteristics, and modifiable risk factors using descriptive statistics.

Results: We identified 776 patients in the Nunavik cohort, of whom 42.0% were transferred to the MGH. Of all 776 trauma patients in Nunavik, only 14.3% were captured in the trauma registry. Among those transferred to the MGH, 33.9% were recorded in the registry, highlighting a gap in data representation. Patients in the Nunavik cohort were significantly younger (30 yr v. 37 yr, p < 0.001) and more often female (51.0% v. 38.8%, p < 0.001). Mechanisms of injury and vital signs also differed significantly (p < 0.001).

Conclusion: Data from many patients from Nunavik are not captured in the governmental database, with the trauma epidemiology in the region significantly differing from those presenting to the tertiary centre. A dedicated prospective, sustainable registry is needed to improve quality of care and outcomes in Nunavik.

Health equity and the social determinants of health are increasingly prioritized in health care delivery across North America and globally, yet academic medicine remains ill equipped to support equity-focused advocacy. We argue that this stems mainly from a gap in recognizing advocacy as an academic pillar alongside research, education, and administration. Advocacy is undervalued in academic medicine, as reflected in teaching, hiring, and promotion criteria and what is published in academic journals. Health equity is essential for the health of populations, and the current structure of academic medicine should be redesigned to recognize, value, and support equity-based advocacy efforts. Advocacy can be integrated in 2 key areas: medical education and faculty roles and promotion pathways. A new academic role, the surgeon-advocate - whose work focuses on the engagement, knowledge dissemination, and administration of advocacy-based work to affect system change - is vital for a paradigm shift that accepts advocacy into the essential work of academic medicine. The concept of a surgeon-advocate is not new and is vital to our identities as physicians. However, formally embracing advocacy within academic institutions represents the paradigm shift needed to move closer to health equity goals. This analysis proposes a critical revision to academic surgery and, more broadly, academic medicine. We provide practical steps to intentionally weave advocacy and health equity into the fabric of academic medical institutions to improve how we practise and serve our patients.

Background: The rapid evolution of genetic testing and availability of information has necessitated increased surgeon participation in genetics-related tasks. We sought to characterize knowledge, perceptions, attitudes, and barriers pertaining to genetic literacy among Canadian surgeons who manage patients with a hereditary predisposition to or confirmed cancer.

Methods: We distributed a Web-based survey to surgeons across Canada from June to December 2023 through relevant surgical societies. We analyzed quantitative and narrative data from the survey descriptively and thematically.

Results: We included 57 participants from 8 provinces (response rate 10%). Many surgeons (28/45, 62%) reported performing risk assessment, but 16% (7/45) reported counselling and 29% (13/45) reported ordering genetic testing. Surgeons reported low confidence in ordering testing and in interpreting and discussing implications of testing results. Most surgeons (35/39, 90%) expressed a desire for improvement in their knowledge and in their confidence in hereditary cancer genetics. Approval and funding for testing, referral to a genetic counsellor or medical geneticist, and availability of genetics clinics were reported as extreme barriers to providing care.

Conclusion: Practising surgeons in Canada participate in many genetics-related tasks, but they report low confidence and face barriers to genetic literacy. There is a need and desire for interventions targeting genetic literacy among surgeons in Canada.

The incidence of early-onset colorectal cancer (CRC), defined as CRC occurring in individuals younger than 50 years, is increasing globally. Emerging evidence suggests that the incidence and prevalence of CRC in individuals aged 45-49 years approach those in individuals aged 50-59 years. To address this concerning trend, many health care systems and clinical specialist societies are advocating for lowering the age of initiation for CRC screening in individuals at average risk to 45 years. The present review, provided by the Canadian Association of General Surgeons Clinical Practice Committee, gives an overview of the current CRC screening guidelines in Canada, the rationale for earlier screening, and the challenges and impact of lowering the screening age to 45 years to health care systems in Canada.

Background: Sex differences in chronic postsurgical pain have been reported, with the main findings indicating that females experience a greater incidence and severity of pain than males; however, it remains unclear to what these sex differences are attributable. We sought to compare pain and related psychological factors between a matched sample of male and female patients 3 months and 1 year after Shouldice repair.

Methods: Male and female participants who underwent Shouldice repair were manually matched 1:1 and compared on 10 variables: age, body mass index, smoking status, preoperative depression and anxiety scores, living status (alone or with others), American Society of Anesthesiologists physical status health classification, preoperative chronic pain, preoperative hernia pain, preoperative pain catastrophizing scores, and nerve handling during surgery. Data on pain were collected from questionnaires administered 3 months and 1 year postoperatively, and data on participant clinical characteristics were collected from operative notes and patient charts.

Results: There were 28 matched male-female pairs at 3 months and 21 at 1 year. The average age preoperatively was 56.18 ± 12.48 years. At 3 months postoperative, 18 females and 6 males had pain (p = 0.001), with females reporting more frequent (p = 0.004) and longer durations (p = 0.005) of pain. The 3-month postoperative Brief Pain Inventory Numeric Rating Scale scores (0-10) showed that in terms of pain severity, females had higher "worst pain" (1.61 ± 1.85 v. 0.32 ± 0.77, p = 0.002), "average pain" (0.86 ± 1.08 v. 0.14 ± 0.45, p = 0.002), and "pain now" (0.43 ± 1.20 v. 0 ± 0, p = 0.010) scores than males. Significant differences were not found in the incidence, severity, frequency, or duration of pain between females and males at 1 year.

Conclusion: After matching on important confounders, sex differences were found in pain frequency, duration, incidence, and severity at 3 months after Shouldice repair. However, by 1 year after surgery the differences were no longer significant.

Trial registration: Clinicaltrials.gov # NCT03986060.

Background: Bibliometric analysis is a research tool for evaluating and analyzing scholarly output and impact within a specific domain. This study aimed to assess the quantity and quality of plastic surgery research conducted by Canadian-affiliated authors from 1999 to 2023.

Methods: We conducted a comprehensive bibliometric analysis using the Web of Science Core Collection to retrieve data from 60 leading plastic surgery journals, focusing on original articles and reviews published between 1999 and 2023. The InCites Benchmarking & Analytics platform evaluated the publications' quantity and quality. Quality assessment employed 2 key metrics:: category-normalized citation impact (CNCI) and the percentage of publications in the top quartile of journals (%Q1) based on impact factors. We used VOSviewer to map collaborative relationships among universities over various periods.

Results: Canada ranked as the 11th leading contributor globally, with 4446 publications. Nationally, the University of Toronto accounted for more than 30% of Canadian contributions. In terms of quality, Canada led with a CNCI of 1.09 and 21% of publications in the %Q1. Within Canada, McMaster University had the highest CNCI at 1.33, while Dalhousie University ranked highest in %Q1 at 32.3%. Our VOSviewer map of institutional collaborations revealed increased cooperation between Canadian universities and international institutions over the last 25 years.

Conclusion: Over the last 25 years, the trajectory of Canadian plastic surgery literature has been characterized by continuous expansion while maintaining high quality. Efforts should be made to continue to increase the quality and quantity of Canadian research while sustaining international collaborations.