Canadian Journal of Surgery最新文献

Background: 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.

Methods: 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.

Results: 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 (p < 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 (p < 0.001).

Conclusion: 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.

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Background: 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.

Methods: 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.

Results: More male (4.7%) than female medical students (1.9%) applied to an orthopedics program (p < 0.001). The proportion of male applicants entering CaRMS who applied to orthopedics followed a quadratic (U-shaped) distribution over time (p = 0.01). The proportion of female applicants remained unchanged from 2013 to 2022 (p > 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; p = 0.3). The proportion of residency spots offered to female applicants remained at around 30%, without significant changes over time (p = 0.1). The number of female orthopedic graduates increased linearly from 2000 to 2021 (p < 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%; p = 0.05), and this gender difference is decreasing over time (p = 0.03).

Conclusion: 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.

Background: 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.

Methods: 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.

Results: 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 (n = 340, 45.8%), advertisements for THA robots (n = 204, 27.5%), and personal experiences (n = 138, 18.6%). Research was discussed in 7.0% (n = 52) of posts. Most accounts belonged to patients or caregivers (n = 177, 23.9%), followed by medical centres (n = 175, 23.6%), news outlets (n = 158, 21.3%), and physicians or researchers (n = 101, 13.6%). Most posts discussing personal experience were positive (n = 70, 50.7%) or neutral (n = 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).

Conclusion: 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.

Contexte: 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 (n = 340, 45,8 %), faisaient la publicité pour des robots d'ATH (n = 204, 27,5 %) et relataient des expériences personnelles (n = 138, 18,6 %). La recherche était abordée dans 7

Background: 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.

Methods: 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.

Results: 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, p < 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, p < 0.001) or weekends (16.3/30 d, p < 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, p = 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, p = 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, p = 0.015).

Conclusion: 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.