Évaluation d’un programme de recherche canadien pour les résidents en anesthésiologie par rapport aux normes nationales à l’aide d’un modèle logique : une étude d’amélioration de la qualité

Background: Canadian specialty training programs are expected to deliver curriculum content and assess competencies related to the CanMEDS Scholar role. We evaluated our residency research program and benchmarked it against national norms for quality improvement purposes. Methods: In 2021, we reviewed departmental curriculum documents and surveyed current and recently graduated residents.  We applied a logic model framework to assess if our program’s inputs, activities, and outputs addressed the relevant CanMeds Scholar competencies.  We then descriptively benchmarked our results against a 2021 environmental scan of Canadian anesthesiology resident research programs. Results: Local program content was successfully mapped to competencies.  The local survey response rate was 40/55 (73%).  In benchmarking, our program excelled in providing milestone-related assessments, research funding, administrative, supervisory, and methodologic support, and requiring a literature review, proposal presentation, and local abstract submission as output.  Acceptable activities to meet research requirements vary greatly among programs.  Balancing competing clinical and research responsibilities was a frequently reported challenge.   Conclusions: The logic model framework was easily applied and demonstrated our program benchmarked well against national norms.  National level dialogue is needed to develop specific, consistent scholar role activities and competency assessments to bridge the gap between expected outcome standards and education practice.Contexte : Les programmes de spécialité canadiens doivent proposer un contenu de formation en lien avec le rôle CanMEDS d’érudit et évaluer les compétences qui s’y attachent. Nous avons évalué notre programme de résidence en recherche par rapport aux normes nationales en la matière à des fins d’amélioration de la qualité. Méthodes : En 2021, nous avons examiné les documents du programme d’études du département et interrogé des résidents et des médecins récemment diplômés. Nous avons utilisé un modèle logique pour déterminer si les intrants, les activités et les extrants de notre programme couvraient adéquatement les compétences pertinentes liées au rôle CanMeds d’érudit. Nous avons ensuite comparé de façon descriptive nos résultats à une analyse du milieu des programmes de résidence canadiens en recherche en anesthésiologie effectuée la même année. Résultats : Nous avons établi une correspondance entre le contenu du programme local et les compétences. Le taux de réponse à l’enquête était de 40/55 (73 %). D’après l’analyse comparative, notre programme se démarque par l’offre d’évaluations d’étape, de fonds de recherche, de soutien administratif, de supervision, d’orientation méthodologique, et, en ce qui concerne les extrants, par l’exigence d’une analyse documentaire, de la présentation d’une proposition et de la soumission d’un résumé à l’université. Les activités admissibles pour répondre aux exigences de la recherche varient considérablement d’un programme à l’autre. De nombreux répondants ont signalé la difficulté de concilier les responsabilités cliniques et de recherche. Conclusions : L’application du modèle logique a été aisée et elle a permis de montrer que notre programme respecte les normes nationales. Un dialogue au niveau national est nécessaire pour définir de manière précise et cohérente les activités et les évaluations des compétences en lien avec le rôle d’érudit afin de combler le fossé entre les normes quant aux résultats attendus et les pratiques des programmes

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Benchmarking a Canadian anesthesiology resident research program against national norms using a logic model framework: A quality improvement study

Background: Canadian specialty training programs are expected to deliver curriculum content and assess competencies related to the CanMEDS Scholar role. We evaluated our residency research program and benchmarked it against national norms for quality improvement purposes.Methods: In 2021, we reviewed departmental curriculum documents and surveyed current and recently graduated residents. We applied a logic model framework to assess if our program’s inputs, activities, and outputs addressed the relevant CanMeds Scholar competencies. We then descriptively benchmarked our results against a 2021 environmental scan of Canadian anesthesiology resident research programs.Results: Local program content was successfully mapped to competencies. The local survey response rate was 40/55 (73%). In benchmarking, our program excelled in providing milestone-related assessments, research funding, administrative, supervisory, and methodologic support, and requiring a literature review, proposal presentation, and local abstract submission as output. Acceptable activities to meet research requirements vary greatly among programs. Balancing competing clinical and research responsibilities was a frequently reported challenge.Conclusions: The logic model framework was easily applied and demonstrated our program benchmarked well against national norms. National level dialogue is needed to develop specific, consistent scholar role activities and competency assessments to bridge the gap between expected outcome standards and education practice.Contexte : Les programmes de spécialité canadiens doivent proposer un contenu de formation en lien avec le rôle CanMEDS d’érudit et évaluer les compétences qui s’y attachent. Nous avons évalué notre programme de résidence en recherche par rapport aux normes nationales en la matière à des fins d’amélioration de la qualité.Méthodes : En 2021, nous avons examiné les documents du programme d’études du département et interrogé des résidents et des médecins récemment diplômés. Nous avons utilisé un modèle logique pour déterminer si les intrants, les activités et les extrants de notre programme couvraient adéquatement les compétences pertinentes liées au rôle CanMeds d’érudit. Nous avons ensuite comparé de façon descriptive nos résultats à une analyse du milieu des programmes de résidence canadiens en recherche en anesthésiologie effectuée la même année.Résultats : Nous avons établi une correspondance entre le contenu du programme local et les compétences. Le taux de réponse à l’enquête était de 40/55 (73 %). D’après l’analyse comparative, notre programme se démarque par l’offre d’évaluations d’étape, de fonds de recherche, de soutien administratif, de supervision, d’orientation méthodologique, et, en ce qui concerne les extrants, par l’exigence d’une analyse documentaire, de la présentation d’une proposition et de la soumission d’un résumé à l’université. Les activités admissibles pour répondre aux exigences de la recherche varient considérablement d’un programme à l’autre. De nombreux répondants ont signalé la difficulté de concilier les responsabilités cliniques et de recherche.Conclusions : L’application du modèle logique a été aisée et elle a permis de montrer que notre programme respecte les normes nationales. Un dialogue au niveau national est nécessaire pour définir de manière précise et cohérente les activités et les évaluations des compétences en lien avec le rôle d’érudit afin de combler le fossé entre les normes quant aux résultats attendus et les pratiques des programmes

A Cost Analysis of Healthcare Episodes Including Day-Case Bariatric Surgery (Roux-en-Y Gastric Bypass and Sleeve Gastrectomy) Versus Inpatient Surgery

Y Background Assessing the medico-economic outcomes of a healthcare pathway including day-case bariatric surgery versus the conventional pathway.Methods This economical evaluation is a prospective cohort study with historical controls. Between March 2019 and December 2020, 30 patients eligible for bariatric surgery were considered in the day-case group. Surgical procedures included sleeve gastrectomy and Roux-en-Y gastric bypass. The day-case pathway included patient education, post-discharge follow-up by a community nurse twice-daily and standardized communications to surgeons. Day-case patients were paired with 30 inpatients, based on the type of intervention, age, and ASA status. The primary outcome was the cost of care episodes from the preoperative visit to the 30-day postoperative visit. Micro-costing methodology and activity-based costing were used. Secondary outcomes included length of hospital stay, rate of unanticipated events, and patient' satisfaction assessment.Results Male-to-female ratio was 1/2. In the day-case versus inpatient group, age, number of associated medical conditions, and BMI (42.9 +/- 4.9 versus 42.6 +/- 4.6, p > 0.05) were similar. In the day-case group, there were 7 overnight stays (23.3%), 3 readmissions (10%), and 4 unscheduled consultations (13.3%). The overall length of hospital stay was significantly shorter (0.65 +/- 0.33, versus 2.9 +/- 0.4 days, p < 0.0001). The complication rate was 6.6% in both groups. The cost of the care episode was euro 4272.9 +/- 589.7 for the day-case group versus euro 4993.7 +/- 695.6 for inpatients, corresponding to a 14.4% cost reduction (p = 0.0254).Conclusions Day-case bariatric surgery appears to be safe and beneficial in terms of costs. It involves a specific organization with postdischarge follow-up. Graphical abstrac

Cannabis use as a factor of lower corpulence in hepatitis C-infected patients: results from the ANRS CO22 Hepather cohort

International audienceBackground: Patients with chronic hepatitis C virus (HCV) infection are at greater risk of developing metabolic disorders. Obesity is a major risk factor for these disorders, and therefore, managing body weight is crucial. Cannabis use, which is common in these patients, has been associated with lower corpulence in various populations. However, this relationship has not yet been studied in persons with chronic HCV infection.Methods: Using baseline data from the French ANRS CO22 Hepather cohort, we used binary logistic and multinomial logistic regression models to test for an inverse relationship between cannabis use (former/current) and (i) central obesity (i.e., large waist circumference) and (ii) overweight and obesity (i.e., elevated body mass index (BMI)) in patients from the cohort who had chronic HCV infection. We also tested for relationships between cannabis use and both waist circumference and BMI as continuous variables, using linear regression models.Results: Among the 6348 participants in the study population, 55% had central obesity, 13.7% had obesity according to their BMI, and 12.4% were current cannabis users. After multivariable adjustment, current cannabis use was associated with lower risk of central obesity (adjusted odds ratio, aOR [95% confidence interval, CI]: 0.45 [0.37-0.55]), BMI-based obesity (adjusted relative risk ratio (aRRR) [95% CI]: 0.27 [0.19-0.39]), and overweight (aRRR [95% CI]: 0.47 [0.38-0.59]). This was also true for former use, but to a lesser extent. Former and current cannabis use were inversely associated with waist circumference and BMI.Conclusions: We found that former and, to a greater extent, current cannabis use were consistently associated with smaller waist circumference, lower BMI, and lower risks of overweight, obesity, and central obesity in patients with chronic HCV infection. Longitudinal studies are needed to confirm these relationships and to assess the effect of cannabis use on corpulence and liver outcomes after HCV cure.Trial registration: ClinicalTrials.gov identifier: NCT01953458

Early Hepatocellular Carcinoma Detection Using Magnetic Resonance Imaging Is Cost-Effective in High-Risk Patients with Cirrhosis

International audienc