Resident work hours: why keeping the status quo may not be such a bad thing

Resident duty hours have become an increasingly debated topic in post-graduate medical education. Work-hour restrictions have been implemented for first-year residents in the US and more recently for all residents in Quebec. Current and future work-hour rules affect a variety of stakeholders: government, hospitals, residency training programs, patients, and most of all residents. In this article, we hope to examine the issue from a Canadian perspective and delineate some of the reasons why changing the current call structure may have potentially deleterious effects to all those concerned

Younger Age and Prognosis in Diverticulitis: A Nationwide Retrospective Cohort Study

BACKGROUND: Traditionally regarded as a disease of the elderly, the incidence of diverticulitis of the colon has been on the rise, especially in younger cohorts. These patients have been found to experience a more aggressive disease course with more frequent hospitalization and greater need for surgical intervention. OBJECTIVE: To characterize factors that portend a poor prognosis in patients diagnosed with diverticulitis; in particular, to evaluate the role of demographic variables on disease course. METHODS: Using the Canadian Institute for Health Information Discharge Abstract Databases, readmission rates, length of stay, colectomy rates and mortality rates in patients hospitalized for diverticulitis were examined. Data were stratified according to age, sex and comorbidity (as defined by the Charlson index). RESULTS: In the cohort ≤30 years of age, a clear male predominance was apparent. Colectomy rate in the index admission, stratified according to age, demonstrated a J-shaped curve, with the highest rate in patients ≤30 years of age (adjusted OR 2.3 [95% CI 1.62 to 3.27]) compared with the 31 to 40 years of age group. In-hospital mortality increased with age. Cumulative rates of readmission at six and 12 months were 6.8% and 8.8%, respectively. CONCLUSION: In the present nationwide cohort study, younger patients (specifically those ≤30 years of age) were at highest risk for colectomy during their index admission for diverticulitis. It is unclear whether this observation was due to more virulent disease among younger patients, or surgeon and patient preferences

Younger Age and Prognosis in Diverticulitis: A Nationwide Retrospective Cohort Study

BACKGROUND: Traditionally regarded as a disease of the elderly, the incidence of diverticulitis of the colon has been on the rise, especially in younger cohorts. These patients have been found to experience a more aggressive disease course with more frequent hospitalization and greater need for surgical intervention

Academic screencasting: Internet-based dissemination of ophthalmology grand rounds

Objective: To evaluate and compare the preferences and attitudes of Ontario ophthalmologists and ophthalmology residents toward screencasting as an educational tool with potential use for continuing medical education (CME) events. Design: Cross-sectional study. Participants: Eighty of 256 participants completed the survey. Methods: The surveys were sent to participants by email, with follow-up via telephone. Study participants were urban and rural Ontario ophthalmologists, registered with the Canadian Ophthalmological Society, and University of Toronto ophthalmology residents. Pre-recorded online presentations - screencasts - were used as the main intervention. Online surveys were used to measure multiple variables evaluating the attitudes of the participants toward screencasting. This data was then used for further quantitative and qualitative analysis. Results: Over 95% of participants replied favourably to the introduction and future utilization of screencasting for educational purposes. Rural ophthalmologists were the most enthusiastic about future events. Practising in rural Ontario was associated with a higher interest in live broadcasts than practising in urban centres (p<0.02), an association supported by qualitative data. Qualitative analysis revealed geographic isolation, busy schedules, ease of use/access, and convenience to be the key factors contributing to interest in screencasting. Conclusions: Practising ophthalmologists and residents in Ontario are interested in academic online screencasting. Rural ophthalmologists were more interested in live lectures than their urban colleagues. More research is required to assess the potential of screencasting as a CME tool.Link_to_subscribed_fulltex

Dissecting Pseudoaneurysm of the Proper Hepatic Artery Repaired by Primary Anastomosis: A Case Report

Background. Although rare, visceral artery pseudoaneurysms often present as surgical emergencies with a specific mortality rate as high as 35% related to aneurysmal rupture. Risk factors for the development of iatrogenic pseudoaneurysms include anticoagulation, female gender, obesity, and vessel calcification. Case Report. We present a case of an elderly female who developed a dissecting pseudoaneurysm of the proper hepatic artery after undergoing routine surgery to resect a large duodenal adenoma. Surgical repair comprised of resection and primary anastomosis was employed resulting in a favourable outcome. Discussion/Conclusion. Surgical management reduces the risk of hepatic ischemia, biliary complications, and abscess formation. Although stenting, coil embolization, and thrombin injection are all plausible options for management, we propose that surgical reconstruction be considered seriously as a treatment for such spontaneous pseudoaneurysms

Survey of Perceptions and Practices among Canadian Gastroenterologists regarding the Prevention of Venous Thromboembolism for Hospitalized Inflammatory Bowel Disease Patients

BACKGROUND: Patients with inflammatory bowel disease (IBD) who are hospitalized with disease flares are known to be at an increased risk of venous thromboembolism (VTE). This is a preventable complication; however, there is currently no standardized approach to the prevention and management of VTE