Keeffe, R. [Atomic Energy Control Board, Canadian Safeguards Support Program, Ottawa, Ontario (Canada)
Canada supports international safeguards as a means by which the proliferation of nuclear weapons can be discouraged. Canada recognizes that,to meet that the IAEA must have effective safeguards techniques and the active cooperation of Member States. Therefore the Canadian Government decided in 1976 to initiate a program in support of IAEA safeguards, known as the Canadian Safeguards Support Program (CSSP). The CSSP is funded and administered by the Atomic Energy Control Board (AECB). The CSSP is a co-ordinated program for the development and the application of safeguards instruments and techniques for nuclear facilities and materials on behalf of the IAEA and also in support of Canada's own national nuclear material safeguards system, implemented by the AECB. (author)
This manual outlines the authorities (acts and regulations), policies and procedures which apply to the Canadian program and which will be used to evaluate regional activities associated with the shellfish Sanitation Program...
Ketovuori, Mikko Mr.
This article is about a multidisciplinary R&D project in which a Canadian Learning Through The Arts (LTTA) program was imported to Finland in 2003–2004. Cultural differences in arts education in Finland and Canada are discussed. While Finland has a national school curriculum with all the arts included. Canada relies more on partnerships to ensure arts education for children in the schools. Despite the fact that Canadian learning methods appeared to be quite similar to the ones Finnish teacher...
Boudreau, P. M.; Breithaupt, R. W.; McNally, J. L.
The progressions and selection of design features for the Canadian segment of a mobile satellite (MSAT) communications system are traced. The feasibility study for a satellite-based public and government mobile communications service to underserved areas was carried out between 1980-82. The results covered the market demand, commercial viability, user cost-benefit, and spacecraft concepts. A subsequent 2 yr study was initiated to proceed with project definition. A market of 1.1 million users was identified in all of Canada, with MSAT replacing other systems for 50 percent of the market. Operations would be in the 806-890 MHz range. Traffic will be routed through gateway links functioning in the 8/7 GHz SHF band while the mobile units will be connected through an 821-825 MHz up link and an 866-870 MH downlink. New technologies will be needed for a central control station, the gateway stations, and the base stations for the mobile radio service, the mobile user terminals, and data collection platforms.
Graves, Roger; And Others
Reports on a survey identifying the location, extent, and focus of technical writing programs at Canadian colleges and universities. Describes representative programs in some detail. Discusses the focus of these programs and the need for more programs. (SR)
Booth, G. H.; Hayes, E. J.; Mamen, R.; Olsen, R. L.; Tsang, E. K.
Canada was involved in the European Space Agency's Olympus satellite program since the beginning. Canadian industry was responsible for the design and manufacture of the large solar array system, intermediate frequency amplifiers, and microwave components as well as playing an important role in the assembly, integration, and test of the satellite and test models which were largely conducted at the Department of Communications' David Florida Laboratory (DFL). This paper describes the salient features of the satellite, special aspects of the testing at the DFL that were driven by the Olympus program, and Canada's part in the post-launch trials and demonstration program which provides Canada with an early opportunity to experiment in the next frequency band to be exploited commercially. The Olympus satellite is a multipurpose three axis stabilized bus capable of carrying a variety of payloads. It has a flexible solar array capable of generating 3.5 kW of power. The multielement payload of the first Olympus satellite includes the following: a two channel, high power television broadcast payload, a four channel 12/14 GHz payload for business services, a 20/30 GHz communications payload primarily aimed at video conferencing and communications systems, and 12/30/30 GHz beacon which will be used to gather propagation information. Testing at the DFL included thermal, vibration, and mass properties measurements and radio frequency testing.
Clinton, L. A.; Haidl, F. M.; Hymers, L. A.; van der Flier-Keller, E.
Established in the early 1970s, EdGEO supports locally driven geosciences workshops for Canadian teachers. Workshops are organized by geoscientists and teachers, and typically have field, laboratory and classroom components. Grants of up to $3000 per workshop are available from the National EdGEO Program. By providing educational opportunities for today's teachers and, through them, their students, EdGEO seeks to cultivate a heightened awareness of our planet. EdGEO workshops provide teachers with potential fieldtrip sites for their students and the knowledge, enthusiasm and materials to inspire their students to engage in geoscience. Networking opportunities with local experts promote the importance of the geoscience profession. The expected result is an improved capacity on the part of Canadians to understand the Earth and to make informed decisions, especially with regard to the use of mineral and energy resources, the maintenance and remediation of the environment, and response to geological hazards. There exists a critical need to provide teachers with training and resources to tackle their Earth science curricula. In 2008, EdGEO supported fourteen workshops, with an unprecedented 521 teachers attending. These teachers then used our resources to reach an estimated 14,000 students during that single academic year. EdGEO workshops are locally driven and are therefore very diverse. Workshops are strongly tied to the provincial curriculum, focus on a specific geoscience topic, or may be largely field-based to demonstrate and practice how field activities could be incorporated into Earth science teaching. Many strive to include all of these important components. Geoscientists and teachers work collaboratively to develop and deliver EdGEO workshops to ensure that the activities can be effectively used in the classroom. The length of these professional development opportunities range from two-hour sessions to several days, and can generally accommodate up to twenty
Sep 12, 2012 ... This award provides young and upcoming professionals with a unique opportunity to strengthen their research skills and gain a fresh perspective on the Canadian community – both in universities and civil society organizations (CSOs) – that is actively engaged in creating, sharing, and using knowledge to ...
van den Akker-Scheek, Inge; Zijlstra, Wiebren; Groothoff, Johan W.; van Horn, Jim R.; Bulstra, Sjoerd K.; Stevens, Martin
Objective: Validation of the program theory of the Groningen orthopaedic exit strategy (GOES), a theory-driven program aiming to improve the rehabilitation of total hip and knee arthroplasty patients after shortened hospital stay. First part of the program theory is the action theory, hypothesising
Bradley, Nori L; Bazzerelli, Amy; Lim, Jenny; Wu Chao Ying, Valerie; Steigerwald, Sarah; Strickland, Matt
Currently, general surgeons provide about 50% of endoscopy services across Canada and an even greater proportion outside large urban centres. It is essential that endoscopy remain a core component of general surgery practice and a core competency of general surgery residency training. The Canadian Association of General Surgeons Residents Committee supports the position that quality endoscopy training for all Canadian general surgery residents is in the best interest of the Canadian public. However, the means by which quality endoscopy training is achieved has not been defined at a national level. Endoscopy training in Canadian general surgery residency programs requires standardization across the country and improved measurement to ensure that competency and basic credentialing requirements are met.
Canada is in the process of developing a Long Term Space Plan that will guide its space endeavors through the first decade of the twenty first century. Later in 1992 the Canadian Space Agency will present its recommendations to the Prime Minister and his Cabinet. The Long Term Space Plan is being developed through a combination of Working Groups with experts from the Canadian government, the largest of Canada's aerospace companies and principal scientists, and cross-Canada consultations with aerospace professionals. The process has reached a broad spectrum of the Canadian professional space community, and many practical proposals have been presented. The Long Term Space Plan development process has been the most extensive in Canadian history, and very successful. It is anticipated that the resulting plan will have wide support. Predictably, Canada's future endeavors in space will build upon our strengths and proven national needs. These include space robotics, communications, remote sensing, earth observation, space science and our astronaut program. International cooperation will continue to be a hallmark of the Canadian Civil Space Program. We may develop facilities and vehicles to allow our space scientists to put small payloads in a microgravity environment. We will continue to enthusiastically participate in the International Space Station Freedom program. However, in the future we will strive to achieve a more equitable fiscal balance between small, medium and large science, technology and application programs.
Liauw, J; Dineley, B; Gerster, K; Hill, N; Costescu, D
To evaluate the current state of abortion training in Canadian Obstetrics and Gynecology residency programs. Surveys were distributed to all Canadian Obstetrics and Gynecology residents and program directors. Data were collected on inclusion of abortion training in the curriculum, structure of the training and expected competency of residents in various abortion procedures. We distributed and collected surveys between November 2014 and May 2015. In total, 301 residents and 15 program directors responded, giving response rates of 55% and 94%, respectively. Based on responses by program directors, half of the programs had "opt-in" abortion training, and half of the programs had "opt-out" abortion training. Upon completion of residency, 66% of residents expected to be competent in providing first-trimester surgical abortion in an ambulatory setting, and 35% expected to be competent in second-trimester surgical abortion. Overall, 15% of residents reported that they were not aware of or did not have access to abortion training within their program, and 69% desired more abortion training during residency. Abortion training in Canadian Obstetrics and Gynecology residency programs is inconsistent, and residents desire more training in abortion. This suggests an ongoing unmet need for training in this area. Policies mandating standardized abortion training in obstetrics and gynecology residency programs are necessary to improve delivery of family planning services to Canadian women. Abortion training in Canadian Obstetrics and Gynecology residency programs is inconsistent, does not meet resident demand and is unlikely to fulfill the Royal College of Physicians and Surgeons of Canada objectives of training in the specialty. Copyright © 2016 Elsevier Inc. All rights reserved.
Harris, Gregory E.
Teacher stress is a significant issue facing the teaching profession. The current paper explores individual stress management as a viable option to address stress in this profession. Specifically, Canadian teacher education programs are examined to identify the prevalence of pre-service teacher education courses focused on individual stress…
Harris, Devin R; Teal, Philip; Turton, Matthew; Lahiffe, Brian; Pulfrey, Simon
Stroke and transient ischemic attack (TIA) are common disorders treated by Canadian emergency physicians. The diagnosis and management of these conditions is time-sensitive and complex, requiring that emergency physicians have adequate training. This study sought to determine the extent of stroke and TIA training in Canadian emergency medicine residency programs. A two-page survey was emailed to directors of all English-speaking emergency medicine residency programs in Canada. This included both the Fellow of the Royal College of Physicians of Canada (FRCPC) and the College of Family Physicians Enhanced Training [CCFP(EM)] residency programs. The number of mandatory and elective rotations, lectures, and examinations relevant to stroke and TIA were assessed. Nine FRCPC programs responded (of 11; RR=82%) and 11 CCFP(EM) programs responded (of 18; RR=61%), representing 20 of 29 programs in Canada (RR: 20/29=69%). Mandatory general neurology (3/9) and stroke neurology (2/9) rotations were offered in a minority of FRCPC programs and not at all in CCFP(EM) programs (0/11). Neuroradiology rotations were mandatory in 1/9 FRCPC programs and no CCFP(EM) programs (0/11). Acute ischemic stroke was allocated 3 hours of lecture time per year in all residency programs, regardless of route of training. Despite the fact that 100% of respondents train residents in facilities that administer thrombolysis for stroke, only 1/11 (9%) CCFP(EM) programs and 0/9 FRCPC programs have residents act as stroke team leaders. Formal training in stroke and TIA is limited in Canadian emergency medicine residency programs. Enhanced training opportunities should be developed as this disease is sudden, life-threatening, and can have disabling or fatal consequences, and therapeutic options are time sensitive.
Ryu, Won Hyung A; Chan, Sonny; Sutherland, Garnette R
The proposed implementation of work hour restrictions has presented a significant challenge of maintaining the quality of resident education and ensuring adequate hands-on experience that is essential for novice surgeons. To maintain the level of resident surgical competency, revision of the apprentice model of surgical education to include supplementary educational methods, such as laboratory and virtual reality (VR) simulations, have become frequent topics of discussion. We aimed to better understand the role of supplementary educational methods in Canadian neurosurgery residency training. An online survey was sent to program directors of all 14 Canadian neurosurgical residency programs and active resident members of the Canadian Neurosurgical Society (N=85). We asked 16 questions focusing on topics of surgeon perception, current implementation and barriers to supplementary educational models. Of the 99 surveys sent, 8 out of 14 (57%) program directors and 37 out of 85 (44%) residents completed the survey. Of the 14 neurosurgery residency programs across Canada, 7 reported utilizing laboratory-based teaching within their educational plan, while only 3 programs reported using VR simulation as a supplementary teaching method. The biggest barriers to implementing supplementary educational methods were resident availability, lack of resources, and cost. Work-hour restrictions threaten to compromise the traditional apprentice model of surgical training. The potential value of supplementary educational methods for surgical education is evident, as reported by both program directors and residents across Canada. However, availability and utilization of laboratory and VR simulations are limited by numerous factors such as time constrains and lack of resources.
Hébert, Marie-Josée; Hartell, David; West, Lori
The Canadian National Transplant Research Program, launched in 2013 with funding from the Canadian Institutes for Health Research and partners, bridges research in the fields of solid organ transplant, hematopoietic cell transplant, and organ donation. We describe the philosophy, structure, accomplishments, and challenges faced by the Canadian National Transplant Research Program to expand on facilitators and overcome roadblocks to successfully developing a transdisciplinary national research structure.
Wetter, Barry; Saghir, Ziad; Mortimer, Alan
An overview is given of the Canadian microgravity sciences program emphasizing the development and progress of microgravity-related research in the areas of materials and life sciences. Activities in the area of materials include: (1) materials processing by means of lasers; (2) crystal growth from melts solutions, and/or biological materials; (3) composite, glass, metal, and alloy materials research; and (4) combustion and fluid physics studies. The life-sciences segment incorporates studies of: cardiovascular/muscular acclimatization, radiation dosimetry, aquatic biology, bone decalcification, neurovestibular adaptations, cell cultures, and metabolism. Experimental payloads and processes are described for such infrastructures as the Mir space station, sounding rockets, drop towers, and the International Microgravity Laboratory. In addition to a significant body of useful scientific data the program contributes to the development of useful R&D hardware such as laser systems and a float-zone furnace.
Drefs, Michelle A.; Schroeder, Meadow; Hiebert, Bryan; Panayotidis, E. Lisa; Winters, Katherine; Kerr, Jamie
This article presents a brief historical review and survey of the current landscape of online graduate psychology programs within the Canadian context. Specific focus is given to outlining the establishment and evolution of the first Canadian online professional specialization program in school psychology. The article argues that given the virtual…
Assiri, Abdullah S; Al-Jarallah, Abdullah S; Al-Amari, Omar; Turnbull, Jeff
The aim of the study was to determine how Saudi medical trainees in Canada perceive their training programs with regards to educational, ethnic and socio-cultural issues, and if different factors such as the chosen field of training, place or level of training make any difference to this perception. All Saudi residents in training programs in Canada in the 1996/1997 academic year were surveyed using a written anonymous self-administered questionnaire, evaluating educational, ethnic and socio-cultural aspects of various training programs. The response rate was 72.5% (185/255). Most of the respondents were in the fourth year of training. Overall, the level of stress was rated as tolerable in 154 (83%), and 179 respondents (96.8%) described the educational aspects of their program positively. Furthermore, 154 (83%) of the respondents agreed that they were treated fairly in the distribution of job functions with regards to Canadian residents, and 133 (72%) did not face any major difficulty in practicing their religion. The sites of training, type of specialty and the level of training made significant impact on the perceived educational, social, religious and administrative aspects of training. The majority of Saudi medical trainees in Canada perceived the educational aspects of their training as a positive experience. Major problems faced were mainly related to administrative matters and to some extent, social adjustment. Issues that affect the training process need to be tackled by the concerned authorities to ensure the success of the training programs.
Duplantier, Neil; Briski, David; Ochsner, John Lockwood; Meyer, Mark; Stanga, Daryl; Chimento, George F
This study's purpose was to assess the impact of a preoperative risk stratification program on joint arthroplasty outcomes at a single institution. We hypothesized that by using a standardized preoperative risk stratification center we would see better outcomes and decreased costs. The triage cohort (T) included 1498 patients assessed at a standardized risk stratification center, and the non-triage cohort (NT) included 1100 patients who did not utilize the center. The T cohort had significantly higher ASA classification (Prisk stratification center can contribute to decreased LOS, increased reimbursement and help prevent complications. Copyright © 2015 Elsevier Inc. All rights reserved.
Jun 24, 2016 ... Eric Smith. Canadian and Latin American researchers are jointly pursuing knowledge in a variety of disciplines, generating ideas and building international networks. For example, in Colombia, researchers from Simon Fraser University and the Centro Internacional de Entrenamiento e Investigaciones ...
Conway, Jason A; Adhikary, Sanjib D; Giampetro, David; Stolzenberg, Dave
To assess the current state of ultrasound training in U.S. and Canadian Chronic Pain Fellowship programs. U.S. as well as Canadian chronic pain fellowship programs were contacted via email and program directors were asked to complete a survey. The surveys were completed online using a questionnaire. Questionnaire via email. None. None. To assess the current state of ultrasound training in U.S. and Canadian Chronic Pain Fellowship programs. Current teaching structure, types, and numbers of ultrasound-guided interventional pain procedures. Thirty-one responses (30.7%) from the 97 U.S. and four Canadian programs surveyed. Of the 31 programs that responded, 26 offered ultrasound training; five did not. These 31 programs averaged 4.1 fellows per year, majority 96.2% of the 26 programs taught ultrasound throughout the fellowship year. The type of ultrasound training varied, with the large majority 96.2% being patient based. Among 26 programs, 96.2% used ultrasound for peripheral nerve blocks, 76.9% used ultrasound for non-axial musculoskeletal injections, and 53.8% used ultrasound for axial nerve blocks. Chronic pain fellowships were teaching ultrasound-guided procedures to their fellows. The majority of the fellowships offered ultrasound training throughout the fellowship year. A majority of training was accomplished via hands-on experience with patients. Chronic pain fellows were receiving a majority of ultrasound training for peripheral nerve blocks, followed by nonaxial musculoskeletal blocks, with few axial nerve blocks being taught. Wiley Periodicals, Inc.
Full Text Available Abstract Background Subacute Sclerosing Panencephalitis (SSPE is so rare in developed countries with measles immunization programs that national active surveillance is now needed to capture sufficient number of cases for meaningful analysis of data. Through the Canadian Paediatric Surveillance Program (CPSP, the SSPE study was able to document a national incidence and determine the epidemiology of affected Canadian children. Methods Between 1997 and 2000, the CPSP surveyed monthly 1978 to 2294 Canadian pediatricians and sub-specialists for SSPE cases. The response rate varied from 82–86% over those years. Results Altogether, four SSPE cases were reported to the CPSP: one case before, two during and one after the study period. The incidence of SSPE in Canadian children was 0.06/million children/year. Of the four cases, diagnosed between ages four and 17 years, three children had measles infection in infancy. All children showed a progressive course of dementia, loss of motor skills and epilepsy. Two children were treated with isoprinosine and intraventricular interferon but died in less than three years from disease onset. One child did not have any treatment and died after seven years of illness. One child received intraventricular ribavirin and remains alive, but markedly impaired, nine years following diagnosis. Conclusion The CPSP has demonstrated that Canadian paediatricians and paediatric neurologists may encounter cases of SSPE. This report highlights the clinical course of affected Canadian children and provides a review of the disease and its management.
Campbell, Craig; Levin, Simon; Humphreys, Peter; Walop, Wikke; Brannan, Renee
Background Subacute Sclerosing Panencephalitis (SSPE) is so rare in developed countries with measles immunization programs that national active surveillance is now needed to capture sufficient number of cases for meaningful analysis of data. Through the Canadian Paediatric Surveillance Program (CPSP), the SSPE study was able to document a national incidence and determine the epidemiology of affected Canadian children. Methods Between 1997 and 2000, the CPSP surveyed monthly 1978 to 2294 Canadian pediatricians and sub-specialists for SSPE cases. The response rate varied from 82–86% over those years. Results Altogether, four SSPE cases were reported to the CPSP: one case before, two during and one after the study period. The incidence of SSPE in Canadian children was 0.06/million children/year. Of the four cases, diagnosed between ages four and 17 years, three children had measles infection in infancy. All children showed a progressive course of dementia, loss of motor skills and epilepsy. Two children were treated with isoprinosine and intraventricular interferon but died in less than three years from disease onset. One child did not have any treatment and died after seven years of illness. One child received intraventricular ribavirin and remains alive, but markedly impaired, nine years following diagnosis. Conclusion The CPSP has demonstrated that Canadian paediatricians and paediatric neurologists may encounter cases of SSPE. This report highlights the clinical course of affected Canadian children and provides a review of the disease and its management. PMID:16356180
Full Text Available Abstract Background Total knee arthroplasty (TKA is a commonly performed surgical procedure in the US. It is important to have a comprehensive inpatient TKA program which maximizes outcomes while minimizing adverse events. The purpose of this study was to describe a TKA program – the Joint Replacement Program (JRP – and report post-surgical outcomes. Methods 74 candidates for a primary TKA were enrolled in the JRP. The JRP was designed to minimize complications and optimize patient-centered outcomes using a team approach including the patient, patient's family, and a multidisciplinary team of health professionals. The JRP consisted of a pre-operative class, standard pathways for medical care, comprehensive peri-operative pain management, aggressive physical therapy (PT, and proactive discharge planning. Measures included functional tests, knee range of motion (ROM, and medical record abstraction of patient demographics, length of stay, discharge disposition, and complications over a 6-month follow-up period. Results All patients achieved medical criteria for hospital discharge. The patients achieved the knee flexion ROM goal of 90° (91.7 ± 5.4°, but did not achieve the knee extension ROM goal of 0° (2.4 ± 2.6°. The length of hospital stay was two days for 53% of the patients, with 39% and 7% discharged in three and four days, respectively. All but three patients were discharged home with functional independence. 68% of these received outpatient physical therapy compared with 32% who received home physical therapy immediately after discharge. Two patients ( Conclusion The comprehensive JRP for TKA was associated with satisfactory clinical outcomes, short lengths of stay, a high percentage of patients discharged home with outpatient PT, and minimal complications. This JRP may represent an efficient, effective and safe protocol for providing care after a TKA.
Fox, Janna; Cheng, Liying; Zumbo, Bruno D.
Few studies have investigated the impact of English language programs on second language (L2) students studying in Canadian universities (Cheng & Fox, 2008; Fox, 2005, 2009). This article reports on questionnaire responses of 641 L2 students studying in 36 English language programs in 26 Canadian universities. The researchers identified…
Tyagi, Rajesh K; Cook, Lori; Olson, John; Belohlav, James
Background Healthcare technology and quality improvement programs have been identified as a means to influence healthcare costs and healthcare quality in Canada. This study seeks to identify whether the ability to implement healthcare technology by a hospital was related to usage of quality improvement programs within the hospital and whether the culture within a hospital plays a role in the adoption of quality improvement programs. Methods A cross-sectional study of Canadian hospitals was co...
Khan, Nadir; Ghatage, Lena; Craighead, Peter S
Cancer agencies within Canada operate with a variety of leadership models, assuming that future leaders are identified, developed and supported by institutions other than their own. A literature review, comprehensive survey and structured interviews were conducted to illuminate the perceptions of leadership in Canadian cancer centres. The major finding from the study is the significant gap between the competencies that leaders acknowledge as being important and the lack of development programs for future and current leaders. The study also showed there is agreement on preferred leadership models and the personal traits that identify future leaders worthy of development. Given the current struggles of leadership, the authors suggest that cancer agencies need to strategize how to advance succession planning and leadership development frameworks.
Young, I; Rajić, A; Hendrick, S; Parker, S; Sanchez, J; McClure, J T; McEwen, S A
To harmonize good production practices (GPP) for dairy producers in Canada, the Canadian dairy industry has developed and is implementing a program called Canadian Quality Milk (CQM). A postal questionnaire was administered to all Canadian dairy producers enrolled in dairy herd-improvement organizations in 2008 (n=10,474) to investigate their attitudes towards the program and to establish baseline information on their use of GPP. The response percentage was 20.9% (2185/10,474). Two-thirds of producers (67.6%) reported participation in CQM and 61.4% of these indicated that the requirements were easy to implement. Most producers (85.0%) reported the use of cats as a pest-control method in their barns. For dead-livestock disposal, 65.0% and 38.0% indicated use of a collection service and burial, respectively. Nearly 40.0% of respondents indicated that they purchase replacement cattle, and somatic cell-count score was the main health indicator considered before purchase. Over 70% of producers reported that they clean and disinfect maternity, calf and weaned-calf pens, while only 34.1% and 53.1% reported that they provide visitors and employees, respectively, with clean clothes and boots. Through latent-class analysis, five groups (classes) of producers with distinctive patterns of reported use of GPP were identified. These were labelled as "minimal", "sanitation-only", "employee-visitor hygiene", "typical" and "ideal" user groups, with 11.1%, 23.8%, 20.2%, 37.1% and 7.7% of respondents, respectively. Respondents in the "ideal users" group had a higher probability of reporting the use of each GPP and were more likely to have completed an educational course in food safety compared to respondents in each other group. They were also more likely to have a herd size in the uppermost quartile (>65 cows) and report participation in CQM compared to each other group except the "employee-visitor hygiene users". The greatest differences were observed when compared to the "minimal
Hebert, Marilynne; Lau, Francis
Eight Canadian universities partnered to establish a Collaborative Health Informatics PhD/Postdoc Strategic Training Program (CHPSTP). The 6-year goal was to increase research capacity in health informatics in Canada. Three cohorts of 20 trainees participated in the training, which included online Research Learning Experiences, annual face-to-face…
Donato, Emily; Lightfoot, Nancy; Carter, Lorraine; MacEwan, Leigh
In 2010, the Canadian Association of Schools of Nursing, the accrediting body for nursing programs in Canada, became part of the Accreditation of Interprofessional Health Education initiative. In turn, interprofessional education (IPE) is now a requirement in nursing curricula. Although the requirement is formally in place, how it is achieved…
Bert, Jack M; Hooper, Jessica; Moen, Sam
Outpatient total joint arthroplasty (OTJA) allows for a safe, cost effective pathway for appropriately selected patients. With current pressures on arthroplasty surgeons and their associated institutions to reduce costs per episode of care, it is important to define the steps and challenges associated with establishing an outpatient arthroplasty program. Several studies have outlined techniques of selecting patients suitable for this type of postoperative pathway. With emerging concerns about patients who undergo outpatient arthroplasty being at increased risk of medical complications, which may lessen projected cost savings, it is important to identify value-based strategies to optimize patient recovery after OTJA. This article reviews digital techniques for patient selection and data collection, operating room efficiency systems, and provides a summary of methods to build and maintain value in outpatient total joint replacement within the framework of bundled payment reimbursement.
Existing alternative transportation programs and initiatives in Canada were presented as part of an effort to achieve the Canada-Wide Standards on Particulate Matter and Ground-level Ozone. This document is intended for employers that could implement support services in their workplace that promote methods of commuting that reduce vehicle kilometers traveled and encourage alternative transportation to the single occupant vehicle with the objective or reducing particulate matter and ground-level ozone. Alternative transportation programs such as employers programs, youth programs and institutional programs have environmental, economic, social and community benefits such as reduced emissions and greater transportation efficiency which lead to improved quality of life, health and sustainability of the transportation system. Organizations implement alternative transportation programs because of a commitment to; environmental responsibility, improving air quality, offering employee benefits, GHG reductions and corporate leadership. The programs are often initiated by large urban centres experiencing transportation-related problems such as congestion, air pollution or infrastructure capacity constraints. The U-Pass was presented as example of a very successful program that promotes change in behaviour at institutions to increase transit ridership. Telework also offers the opportunity of eliminating commutes. Ridematching is another key marketing tool employed by many organizations. The most successful programs are those with the greatest financial resources because sustained funding is necessary for program delivery, expansion and community acceptance. refs., tabs., figs.
Pauls, Merril A
To document the scope of the teaching and evaluation of ethics and professionalism in Canadian family medicine postgraduate training programs, and to identify barriers to the teaching and evaluation of ethics and professionalism. A survey was developed in collaboration with the Committee on Ethics of the College of Family Physicians of Canada. The data are reported descriptively and in aggregate. Canadian postgraduate family medicine training programs. Between June and December of 2008, all 17 Canadian postgraduate family medicine training programs were invited to participate. The first part of the survey explored the structure, resources, methods, scheduled hours, and barriers to teaching ethics and professionalism. The second section focused on end-of-rotation evaluations, other evaluation strategies, and barriers related to the evaluation of ethics and professionalism. Eighty-eight percent of programs completed the survey. Most respondents (87%) had learning objectives specifically for ethics and professionalism, and 87% had family doctors with training or interest in the area leading their efforts. Two-thirds of responding programs had less than 10 hours of scheduled instruction per year, and the most common barriers to effective teaching were the need for faculty development, competing learning needs, and lack of resident interest. Ninety-three percent of respondents assessed ethics and professionalism on their end-of-rotation evaluations, with 86% assessing specific domains. The most common barriers to evaluation were a lack of suitable tools and a lack of faculty comfort and interest. By far most Canadian family medicine postgraduate training programs had learning objectives and designated faculty leads in ethics and professionalism, yet there was little curricular time dedicated to these areas and a perceived lack of resident interest and faculty expertise. Most programs evaluated ethics and professionalism as part of their end-of-rotation evaluations, but
Full Text Available Objectives: Typical rehabilitation programs following total hip arthroplasty and total knee arthroplasty include joint range of motion and muscle-strengthening exercises. Balance and balance exercises following total hip arthroplasty and total knee arthroplasty have not received much attention. The purpose of this study was to determine whether an intervention of balance exercises added to a typical rehabilitation program positively affects patients’ balance. Methods: A total of 63 patients were provided with outpatient physical therapy at their home. Patients were randomly assigned to either typical (n = 33 or balance (n = 30 exercise group. The typical group completed seven typical surgery-specific joint range of motion and muscle-strengthening exercises, while the balance group completed the typical exercises plus three balance exercises. After 5 weeks of administering the rehabilitation program, patients’ balance was assessed on a force plate using 95% ellipse area of the center of pressure amplitude. Results: Patients in the balance group demonstrated significant reduction in the 95% ellipse area for the anterior and posterior lean standing conditions (p < 0.01. Conclusion: Balance exercises added to the typical outpatient physical therapy program resulted in significantly greater improvements in balance for participants with total hip arthroplasty or total knee arthroplasty, compared to the typical exercise program alone. Physical therapists might consider the use of balance exercises to improve balance in individuals in the acute post-operative phase following total hip arthroplasty or total knee arthroplasty.
Paul, Baldeep; Baranchuk, Adrian
Electrocardiography (ECG) interpretation is an essential skill for a family physician. Teaching and learning electrocardiography is a difficult task, in part due to the erosion of knowledge when interpretation is not part of a daily activity. The objective of this study was to assess the current status of electrocardiography teaching in Canadian family medicine residency programs. A national survey was designed to specifically address the status of the ECG teaching curricula. This national survey was electronically sent to the family medicine program directors of all 17 Canadian accredited medical schools. Approximately 75% of the schools responded to the survey. There was a great variance among Canadian family medicine residency programs with respect to the time allotment, ECG training location, training faculty, and teaching methods utilized. The goals of each respective program are also quite wide-ranging. Family medicine residency programs across Canada are quite diverse regarding ECG training curricula and its goals. The need for a homogeneous way of teaching and evaluating has been identified.
Lyons, Jennifer L; Coleman, Mary E; Engstrom, John W; Mateen, Farrah J
To ascertain the current status of global health training and humanitarian relief opportunities in US and Canadian postgraduate neurology programs. There is a growing interest among North American trainees to pursue medical electives in low- and middle-income countries. Such training opportunities provide many educational and humanitarian benefits but also pose several challenges related to organization, human resources, funding, and trainee and patient safety. The current support and engagement of neurology postgraduate training programs for trainees to pursue international rotations is unknown. A survey was distributed to all program directors in the United States and Canada (December 2012-February 2013) through the American Academy of Neurology to assess the training opportunities, institutional partnerships, and support available for international neurology electives. Approximately half of responding programs (53%) allow residents to pursue global health-related electives, and 11% reported that at least 1 trainee participated in humanitarian relief during training (survey response rate 61%, 143/234 program directors). Canadian programs were more likely to allow residents to pursue international electives than US programs (10/11, 91% vs 65/129, 50%, p = 0.023). The number of trainees participating in international electives was low: 0%-9% of residents (55% of programs) and 10%-19% of residents (21% of programs). Lack of funding was the most commonly cited reason for residents not participating in global health electives. If funding was available, 93% of program directors stated there would be time for residents to participate. Most program directors (75%) were interested in further information on global health electives. In spite of high perceived interest, only half of US neurology training programs include international electives, mostly due to a reported lack of funding. By contrast, the majority of Canadian programs that responded allow international
Poor mothers and their families constitute a core dilemma for a social welfare system that aims primarily to encourage and keep workers in the labor force. Public income transfers to these and other marginalized groups may be viewed as disincentives to seek paid work and have been characterized in Canada by stinginess and contradictions since the beginning of the XX century. This paper discusses recent transformations in these programs and their effects on families and individuals. Focusing specifically on poor mothers raising children alone, it argues that many gradual cuts and reshaping these programs have changed the character of the social welfare state in Canada, blocking escape routes from poverty for marginalized groups.
Tam, V C; Berry, S; Hsu, T; North, S; Neville, A; Chan, K; Verma, S
The oncology education framework currently in use in Canadian medical training programs is unknown, and the needs of learners have not been fully assessed to determine whether they are adequately prepared to manage patients with cancer. To assess the oncology education framework currently in use at Canadian medical schools and residency training programs for family (fm) and internal medicine (im), and to evaluate opinions about the content and utility of standard oncology education objectives, a Web survey was designed and sent to educators and learners. The survey recipients included undergraduate medical education curriculum committee members (umeccms), directors of fm and im programs, oncologists, medical students, and fm and im residents. Survey responses were received from 677 educators and learners. Oncology education was felt to be inadequate in their respective programs by 58% of umeccms, 57% of fm program directors, and 50% of im program directors. For learners, oncology education was thought to be inadequate by 67% of medical students, 86% of fm residents, and 63% of im residents. When comparing teaching of medical subspecialty-related diseases, all groups agreed that their trainees were least prepared to manage patients with cancer. A standard set of oncology objectives was thought to be possibly or definitely useful for undergraduate learners by 59% of respondents overall and by 61% of postgraduate learners. Oncology education in Canadian undergraduate and postgraduate fm and im training programs are currently thought to be inadequate by a majority of educators and learners. Developing a standard set of oncology objectives might address the needs of learners.
Tam, V.C.; Berry, S.; Hsu, T.; North, S.; Neville, A.; Chan, K.; Verma, S.
Background The oncology education framework currently in use in Canadian medical training programs is unknown, and the needs of learners have not been fully assessed to determine whether they are adequately prepared to manage patients with cancer. Methods To assess the oncology education framework currently in use at Canadian medical schools and residency training programs for family (fm) and internal medicine (im), and to evaluate opinions about the content and utility of standard oncology education objectives, a Web survey was designed and sent to educators and learners. The survey recipients included undergraduate medical education curriculum committee members (umeccms), directors of fm and im programs, oncologists, medical students, and fm and im residents. Results Survey responses were received from 677 educators and learners. Oncology education was felt to be inadequate in their respective programs by 58% of umeccms, 57% of fm program directors, and 50% of im program directors. For learners, oncology education was thought to be inadequate by 67% of medical students, 86% of fm residents, and 63% of im residents. When comparing teaching of medical subspecialty–related diseases, all groups agreed that their trainees were least prepared to manage patients with cancer. A standard set of oncology objectives was thought to be possibly or definitely useful for undergraduate learners by 59% of respondents overall and by 61% of postgraduate learners. Conclusions Oncology education in Canadian undergraduate and postgraduate fm and im training programs are currently thought to be inadequate by a majority of educators and learners. Developing a standard set of oncology objectives might address the needs of learners. PMID:24523624
Hancock, Jennifer; Shemie, Sam D; Lotherington, Ken; Appleby, Amber; Hall, Richard
The purpose of this survey was to determine how Canadian healthcare professionals perceive their deficiencies and educational requirements related to organ and tissue donation. We surveyed 641 intensive care unit (ICU) physicians, 1,349 ICU nurses, 1,561 emergency room (ER) physicians, and 1,873 ER nurses. The survey was distributed by the national organization for each profession (the Canadian Association of Emergency Physicians, the Canadian Association of Critical Care Nurses, and the National Emergency Nurses Association). Canadian Blood Services developed the critical care physician list in collaboration with the Canadian Critical Care Society. Survey development included questions related to comfort with, and knowledge of, key competencies in organ and tissue donation. Eight hundred thirty-one (15.3%) of a possible 5,424 respondents participated in the survey. Over 50% of respondents rated the following topics as highly important: knowledge of general organ and tissue donation, neurological determination of death, donation after cardiac death, and medical-legal donation issues. High competency comfort levels ranged from 14.7-50.9% for ICU nurses and 8.0-34.6% for ER nurses. Competency comfort levels were higher for ICU physicians (67.5-85.6%) than for ER physicians who rated all competencies lower. Respondents identified a need for a curriculum on national organ donation and preferred e-learning as the method of education. Both ICU nurses and ER practitioners expressed low comfort levels with their competencies regarding organ donation. Intensive care unit physicians had a much higher level of comfort; however, the majority of these respondents were specialty trained and working in academic centres with active donation and transplant programs. A national organ donation curriculum is needed.
Reutter, Linda; Paul, Pauline; Sales, Anne; Jerke, Hannah; Lee, Anra; McColl, Meighan; Stafford, Erin; Visram, Alysha
In this article, we describe the development of a BScN (Honors) Program in a large Canadian university. We describe the elements of the program, including the application of a research apprenticeship model as the core of the program. We provide examples of student learning experiences culminating in the Honors project. Recruitment, balancing clinical and research interests, financial support, and manageability of the Honors project emerged as key challenges in our first offerings of the program. Overall, students perceived that experiential research learning enhanced their research skills, increased appreciation of the process and outcomes of nursing research, and inspired confidence to pursue graduate education. We conclude that an apprenticeship model providing students with experiential research learning with established faculty researchers is an effective and efficient way to deliver the Honors Program in the context of a research-intensive nursing faculty. Copyright 2009 Elsevier Ltd. All rights reserved.
Wong, Jonathan; Finan, Emer; Campbell, Douglas
Introduction Simulation is used for the delivery of education and on occasion assessment. Before such a tool is used routinely in neonatal training programs across Canada, a need assessment is required to determine its current usage by accredited training programs. Our aim was to characterize the type of simulation modalities used and the perceived simulation-based training needs in Canadian neonatal-perinatal medicine (NPM) training programs. Methods A 22-item and 13-item online descriptive survey was sent to all NPM program directors and fellows in Canada, respectively. The survey was modeled on a previously validated tool by Johnston, et al. and responses were collected over 30 days. Results In total, eight (63%) program directors and 24 (28%) fellows completed the survey, with all respondents indicating that simulation is being used. Both lab-based and in situ simulations are occurring, with a range of simulation modalities employed to primarily teach resuscitation, procedural and communication skills. Fellows indicated that simulation should also be used to also teach other important topics, including disease-specific management, crisis resource management, and prevention of medical error. Five (63%) programs have faculty with formal simulation training and four (50%) programs have at least one faculty involved in simulation research. Conclusion Simulation is widely used in Canadian NPM training programs, with program directors and fellows identifying this as an important tool. Simulation can be used to teach a range of skills, but programs need to align their curriculum with both training objectives and learner needs. There is an opportunity for faculty development and increased simulation research.
Full Text Available Abstract Background At a time of increased need and demand for general internists in Canada, the attractiveness of generalist careers (including general internal medicine, GIM has been falling as evidenced by the low number of residents choosing this specialty. One hypothesis for the lack of interest in a generalist career is lack of comfort with the skills needed to practice after training, and the mismatch between the tertiary care, inpatient training environment and "real life". This project was designed to determine perceived effectiveness of training for 10 years of graduates of Canadian GIM programs to assist in the development of curriculum and objectives for general internists that will meet the needs of graduates and ultimately society. Methods Mailed survey designed to explore perceived importance of training for and preparation for various aspects of Canadian GIM practice. After extensive piloting of the survey, including a pilot survey of two universities to improve the questionnaire, all graduates of the 16 universities over the previous ten years were surveyed. Results Gaps (difference between importance and preparation were demonstrated in many of the CanMEDS 2000/2005® competencies. Medical problems of pregnancy, perioperative care, pain management, chronic care, ambulatory care and community GIM rotations were the medical expert areas with the largest gaps. Exposure to procedural skills was perceived to be lacking. Some procedural skills valued as important for current GIM trainees and performed frequently (example ambulatory ECG interpretation had low preparation ratings by trainees. Other areas of perceived discrepancy between training and practice included: manager role (set up of an office, health advocate (counseling for prevention, for example smoking cessation, and professional (end of life issues, ethics. Conclusion Graduates of Canadian GIM training programs over the last ten years have identified perceived gaps
Halton, Jacqueline M; Hand, Jack; Byron, Patricia; Strother, Douglas; Blanchette, Victor
A Human Resources (HR) Committee of C17, the national network of Canadian academic pediatric hematology/oncology programs, obtained comprehensive data enabling analysis and planning for the physician workforce. This study establishes physician to patient ratios and predicts workforce needs for Canadian pediatric hematology/oncology programs. Over a 10-year period, six surveys were sent to the 17 pediatric tertiary care centers treating children with cancer and blood disorders. Data were obtained on physician demographics, full time equivalent (FTE) positions, and time spent in clinical, research, education, and administrative activities. Survey results were debated at the C17 national meetings to obtain consensus on workload ratios. Since 1999, the pediatric hematologist/oncologist workforce has increased from 71 FTE (43 oncology, 20 hematology, 8 BMT) to 109.5 FTE positions (69.7 oncology, 29.4 hematology, and 10.4 BMT). The median age of pediatric hematologists/oncologists increased from 46 years to 52 years and the male to female ratio changed from 1.8:1 to 0.9:1. The 2011 job profile showed the median time spent on activities was 60% clinical, 15% education, 15% research, and 10% administration. After assessing workload, models of care, and optimal physician FTE per program, the C17 HR Committee recommended a ratio of one oncologist per 15 newly diagnosed patients with malignancy and a ratio of one BMT physician per 15 transplants. For every 2.5 oncologists, a 1.0 hematologist is the minimum required. Physician staffing ratios for pediatric hematology/oncology programs have been established and should be adopted across Canadian academic institutions as a standard. Copyright © 2012 Wiley Periodicals, Inc.
Laliberté, Maude; Hudon, Anne; Mazer, Barbara; Hunt, Matthew R; Ehrmann Feldman, Debbie; Williams-Jones, Bryn
The purpose of this study was to examine current approaches and challenges to teaching ethics in entry-level Canadian physiotherapy (PT) and occupational therapy (OT) programs. Educators responsible for teaching ethics in the 28 Canadian PT and OT programs (n = 55) completed an online survey. The quantity of ethics teaching is highly variable, ranging from 5 to 65 h. Diverse obstacles to ethics teaching were reported, relating to the organization and structure of academic programs, student issues and the topic of ethics itself. Specific challenges included time constraints, large class sizes, a lack of pedagogical tools adapted to teaching this complex subject, a perceived lack of student interest for the subject and a preference for topics related to clinical skills. Of note, 65% of ethics educators who participated in the survey did not have any specialized training in ethics. Significant cross-program variation in the number of hours dedicated to ethics and the diversity of pedagogical methods used suggests that there is little consensus about how best to teach ethics. Further research on ethics pedagogy in PT and OT programs (i.e. teaching and evaluation approaches and effectiveness of current ethics teaching) would support the implementation of more evidence-based ethics education. Implications for Rehabilitation Ethics educators in Canadian PT and OT programs are experimenting with diverse educational approaches to teach ethical reasoning and decision-making to students, including lectures, problem-based learning, directed readings, videos, conceptual maps and clinical elective debriefing, but no particular method has been shown to be more effective for developing ethical decision-making/reasoning. Thus, research on the effectiveness of current methods is needed to support ethics educators and programs to implement evidence-based ethics education training. In our survey, 65% of ethics educators did not have any specialized training in ethics. Ensuring
The window and door industry in North America have a strong interest in harmonizing US and Canadian rating procedures and standards for predicting the thermal performance of their products. The costs and time associated with complying with the requirements in both countries are significant and could be reduced through reciprocity. The purpose of this paper is to compare the US and Canadian rating programs. Joint efforts between the US and Canada can use this information to focus on reconciling the differences and to work towards reciprocity. The following identifies the applicable procedures and standards for both countries, and summarizes the major differences in the products that are covered, the sizes that are used, the U-factor and solar heat gain coefficient calculational and test methods, air leakage measurement, prediction of annual energy use, condensation resistance methods, reporting requirements, and accreditation and certification programs. The major differences between the system s are identified and recommendations are made to achieve reciprocity. The appendix contains a paper that is a synopsis of the findings from this study.
Pérez, Teresa; Makrestsov, Nikita; Garatt, John; Torlakovic, Emina; Gilks, C Blake; Mallett, Susan
The Canadian Immunohistochemistry Quality Control program monitors clinical laboratory performance for estrogen receptor and progesterone receptor tests used in breast cancer treatment management in Canada. Current methods assess sensitivity and specificity at each time point, compared with a reference standard. We investigate alternative performance analysis methods to enhance the quality assessment. We used 3 methods of analysis: meta-analysis of sensitivity and specificity of each laboratory across all time points; sensitivity and specificity at each time point for each laboratory; and fitting models for repeated measurements to examine differences between laboratories adjusted by test and time point. Results show 88 laboratories participated in quality control at up to 13 time points using typically 37 to 54 histology samples. In meta-analysis across all time points no laboratories have sensitivity or specificity below 80%. Current methods, presenting sensitivity and specificity separately for each run, result in wide 95% confidence intervals, typically spanning 15% to 30%. Models of a single diagnostic outcome demonstrated that 82% to 100% of laboratories had no difference to reference standard for estrogen receptor and 75% to 100% for progesterone receptor, with the exception of 1 progesterone receptor run. Laboratories with significant differences to reference standard identified with Generalized Estimating Equation modeling also have reduced performance by meta-analysis across all time points. The Canadian Immunohistochemistry Quality Control program has a good design, and with this modeling approach has sufficient precision to measure performance at each time point and allow laboratories with a significantly lower performance to be targeted for advice.
Groen, Janet; Hyland-Russell, Tara
This article examines the community-university partnerships and the planning process of three Canadian Radical Humanities programs: programs that offer university entry-level humanities to adult learners on the margins of society. Examining these three iterations has revealed the significance of program origins, particularly the introduction of…
Lam, Mindy CW; Sey, Michael SL; Gregor, Jamie; Wong, Clarence
The Canadian Association of Gastroenterology (CAG) Scholars’ Program (previously known as the Bright Lights Course) is designed to encourage trainees to consider a subspecialty career in gastroenterology. A formal analysis of the Scholars’ Program performed in 2007 revealed that 82% of participants invited to the program pursued or were planning to pursue a career in gastroenterology. The positive results are consistent with the CAG’s strategic plan of developing “the next generation of gastroenterology clinical practitioners, researchers, educators, and leaders” and to “attract, train, and retain the best and the brightest to gastroenterology”. The present study was a follow-up analysis of participants in the Scholars’ Program between 2006 and 2012. Although 93.1% of participants had an interest in gastroenterology before attending the Scholars’ Program, the majority (68.7%) reported a greater interest in gastroenterology after the program. Similar to the study from 2007, the present study again illustrates the importance and success of the Scholars’ Program in generating interest and retaining candidates in gastroenterology. PMID:24288694
Lam, Mindy Ching Wan; Sey, Michael Sl; Gregor, Jamie; Wong, Clarence
The Canadian Association of Gastroenterology (CAG) Scholars' Program (previously known as the Bright Lights Course) is designed to encourage trainees to consider a subspecialty career in gastroenterology. A formal analysis of the Scholars' Program performed in 2007 revealed that 82% of participants invited to the program pursued or were planning to pursue a career in gastroenterology. The positive results are consistent with the CAG's strategic plan of developing "the next generation of gastroenterology clinical practitioners, researchers, educators, and leaders" and to "attract, train, and retain the best and the brightest to gastroenterology". The present study was a follow-up analysis of participants in the Scholars' Program between 2006 and 2012. Although 93.1% of participants had an interest in gastroenterology before attending the Scholars' Program, the majority (68.7%) reported a greater interest in gastroenterology after the program. Similar to the study from 2007, the present study again illustrates the importance and success of the Scholars' Program in generating interest and retaining candidates in gastroenterology.
McIntyre, Lynn; Kwok, Cynthia; Emery, J C Herbert; Dutton, Daniel J
Although there is widespread recognition that poverty is a key determinant of health, there has been less research on the impact of poverty reduction on health. Recent calls for a guaranteed annual income (GAI), defined as regular income provided to citizens by the state regardless of work status, raise questions about the impact, relative to the costs, of such a population health intervention. The objective of this study was to determine the impact of Canadian seniors' benefits (Old Age Security/Guaranteed Income Supplement, analogous to a GAI program) on the self-reported health, self-reported mental health and functional health of age-eligible, low-income seniors. We used the 2009-2010 Canadian Community Health Survey to examine unattached adult respondents with an annual income of $20,000 or less, stratified by seniors' benefits/GAI eligibility (55-64 years: ineligible; 65-74 years: eligible). Using regression, we assessed self-reported health, selfreported mental health and functional health as measured by the Health Utilities Index, as outcomes for seniors' benefits/GAI-eligible and -ineligible groups. We found that individuals age-eligible for seniors' benefits/GAI had better health outcomes than recipients of conditional income assistance programs. Eligibility for seniors' benefits/GAI after age 64 was associated with better self-reported health, functional health and self-reported mental health outcomes, and these effects were observed until age 74. Using seniors' benefits as an example, a GAI leads to significantly better mental health and improved health overall. These improvements are likely to yield reduced health care costs, which may offset the costs associated with program expansion.
... older or have non-injury arthritis (such as rheumatoid arthritis), complete loss of joint space or severe deformities, ... physical therapy treatments also should avoid distraction arthroplasty. Arthritis that is ... from the leg bone (tibia) down to the foot. The frame is attached to the bone by ...
Godefroy, Andrew B
Canada’s space efforts from its origins towards the end of the Second World War through to its participation in the ISS today are revealed in full in this complete and carefully researched history. Employing recently declassified archives and many never previously used sources, author Andrew B. Godefroy explains the history of the program through its policy and many fascinating projects. He assesses its effectiveness as a major partner in both US and international space programs, examines its current national priorities and capabilities, and outlines the country’s plans for the future. Despite being the third nation to launch a satellite into space after the Soviet Union and the United States; being a major partner in the US space shuttle program with the iconic Canadarm; being an international leader in the development of space robotics; and acting as one of the five major partners in the ISS, the Canadian Space Program remains one of the least well-known national efforts of the space age. This book atte...
The effectiveness of the use of a digital activity coaching system in addition to a two-week home-based exercise program in patients after total knee arthroplasty: study protocol for a randomized controlled trial
Harmelink, K.E.M.; Zeegers, A.; Tonis, T.M.; Hullegie, W.; Nijhuis-Van der Sanden, M.W.G.; Staal, J.B.
BACKGROUND: There is consistent evidence that supervised programs are not superior to home-based programs after total knee arthroplasty (TKA), especially in patients without complications. Home-based exercise programs are effective, but we hypothesize that their effectiveness can be improved by
Full Text Available BACKGROUND: A 1996 preproject survey among Canadian Hospital Epidemiology Committee (CHEC sites revealed variations in the prevention, detection, management and surveillance of Clostridium difficile-associated diarrhea (CDAD. Facilities wanted to establish national rates of nosocomially acquired CDAD (N-CDAD to understand the impact of control or prevention measures, and the burden of N-CDAD on health care resources. The CHEC, in collaboration with the Laboratory Centre for Disease Control (Health Canada and under the Canadian Nosocomial Infection Surveillance Program, undertook a prevalence surveillance project among selected hospitals throughout Canada.
Full Text Available There is a global recognition that immunization is one of the most cost-effective public health interventions which should be available to everyone. The equity approach to immunization provides a holistic and integrated framework for addressing inequalities and disproportions in the realization of human rights. The aim of this study is to review the performance of the immunization programs in Canada through an equity lens using two analytical frameworks for immunization programs. It focuses on four elements of the programs: a the burden of disease; b immunization strategy; c ability to evaluate; and d research questions. To achieve universal access to vaccination, Canada should have a strong connection with human rights, where realities and outreach need to be prioritized. Preventable diseases such as influenza, H1N1, and varicella have been reported specifically in Aboriginal Canadians, immigrants and refugees. Our study seeks to demonstrate that access to vaccines should be considered one of the most vital human rights and as a matter of fundamental intervention to achieve health equity.
Maclean, Lynne M; Clinton, Kathryn; Edwards, Nancy; Garrard, Michael; Ashley, Lisa; Hansen-Ketchum, Patti; Walsh, Audrey
Increasingly, multiple intervention programming is being understood and implemented as a key approach to developing public health initiatives and strategies. Using socio-ecological and population health perspectives, multiple intervention programming approaches are aimed at providing coordinated and strategic comprehensive programs operating over system levels and across sectors, allowing practitioners and decision makers to take advantage of synergistic effects. These approaches also require vertical and horizontal (v/h) integration of policy and practice in order to be maximally effective. This paper examines v/h integration of interventions for childhood overweight/obesity prevention and reduction from a Canadian perspective. It describes the implications of v/h integration for childhood overweight and obesity prevention, with examples of interventions where v/h integration has been implemented. An application of a conceptual framework for structuring v/h integration of an overweight/obesity prevention initiative is presented. The paper concludes with a discussion of the implications of vertical/horizontal integration for policy, research, and practice related to childhood overweight and obesity prevention multiple intervention programs. Both v/h integration across sectors and over system levels are needed to fully support multiple intervention programs of the complexity and scope required by obesity issues. V/h integration requires attention to system structures and processes. A conceptual framework is needed to support policy alignment, multi-level evaluation, and ongoing coordination of people at the front lines of practice. Using such tools to achieve integration may enhance sustainability, increase effectiveness of prevention and reduction efforts, decrease stigmatization, and lead to new ways to relate the environment to people and people to the environment for better health for children.
Full Text Available Abstract Background Increasingly, multiple intervention programming is being understood and implemented as a key approach to developing public health initiatives and strategies. Using socio-ecological and population health perspectives, multiple intervention programming approaches are aimed at providing coordinated and strategic comprehensive programs operating over system levels and across sectors, allowing practitioners and decision makers to take advantage of synergistic effects. These approaches also require vertical and horizontal (v/h integration of policy and practice in order to be maximally effective. Discussion This paper examines v/h integration of interventions for childhood overweight/obesity prevention and reduction from a Canadian perspective. It describes the implications of v/h integration for childhood overweight and obesity prevention, with examples of interventions where v/h integration has been implemented. An application of a conceptual framework for structuring v/h integration of an overweight/obesity prevention initiative is presented. The paper concludes with a discussion of the implications of vertical/horizontal integration for policy, research, and practice related to childhood overweight and obesity prevention multiple intervention programs. Summary Both v/h integration across sectors and over system levels are needed to fully support multiple intervention programs of the complexity and scope required by obesity issues. V/h integration requires attention to system structures and processes. A conceptual framework is needed to support policy alignment, multi-level evaluation, and ongoing coordination of people at the front lines of practice. Using such tools to achieve integration may enhance sustainability, increase effectiveness of prevention and reduction efforts, decrease stigmatization, and lead to new ways to relate the environment to people and people to the environment for better health for children.
Hackam, Daniel G; Khan, Nadia A; Hemmelgarn, Brenda R; Rabkin, Simon W; Touyz, Rhian M; Campbell, Norman R C; Padwal, Raj; Campbell, Tavis S; Lindsay, M Patrice; Hill, Michael D; Quinn, Robert R; Mahon, Jeff L; Herman, Robert J; Schiffrin, Ernesto L; Ruzicka, Marcel; Larochelle, Pierre; Feldman, Ross D; Lebel, Marcel; Poirier, Luc; Arnold, J Malcolm O; Moe, Gordon W; Howlett, Jonathan G; Trudeau, Luc; Bacon, Simon L; Petrella, Robert J; Milot, Alain; Stone, James A; Drouin, Denis; Boulanger, Jean-Martin; Sharma, Mukul; Hamet, Pavel; Fodor, George; Dresser, George K; Carruthers, S George; Pylypchuk, George; Burgess, Ellen D; Burns, Kevin D; Vallée, Michel; Prasad, G V Ramesh; Gilbert, Richard E; Leiter, Lawrence A; Jones, Charlotte; Ogilvie, Richard I; Woo, Vincent; McFarlane, Philip A; Hegele, Robert A; Tobe, Sheldon W
inhibitor plus a long-acting dihydropyridine CCB is preferable to an ACE inhibitor plus a thiazide diuretic. All hypertensive patients with dyslipidemia should be treated using the thresholds, targets and agents outlined in the Canadian lipid treatment guidelines. Selected patients with hypertension who do not achieve thresholds for statin therapy, but who are otherwise at high risk for cardiovascular events, should nonetheless receive statin therapy. Once blood pressure is controlled, low-dose acetylsalicylic acid therapy should be considered. All recommendations were graded according to the strength of the evidence and voted on by the 63 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 80% consensus. These guidelines will continue to be updated annually. The Canadian Hypertension Education Program process is sponsored by the Canadian Hypertension Society, Blood Pressure Canada, the Public Health Agency of Canada, the College of Family Physicians of Canada, the Canadian Pharmacists Association, the Canadian Council of Cardiovascular Nurses, and the Heart and Stroke Foundation of Canada.
Hackam, Daniel G; Khan, Nadia A; Hemmelgarn, Brenda R; Rabkin, Simon W; Touyz, Rhian M; Campbell, Norman RC; Padwal, Raj; Campbell, Tavis S; Lindsay, M Patrice; Hill, Michael D; Quinn, Robert R; Mahon, Jeff L; Herman, Robert J; Schiffrin, Ernesto L; Ruzicka, Marcel; Larochelle, Pierre; Feldman, Ross D; Lebel, Marcel; Poirier, Luc; Arnold, J Malcolm O; Moe, Gordon W; Howlett, Jonathan G; Trudeau, Luc; Bacon, Simon L; Petrella, Robert J; Milot, Alain; Stone, James A; Drouin, Denis; Boulanger, Jean-Martin; Sharma, Mukul; Hamet, Pavel; Fodor, George; Dresser, George K; Carruthers, S George; Pylypchuk, George; Burgess, Ellen D; Burns, Kevin D; Vallée, Michel; Prasad, GV Ramesh; Gilbert, Richard E; Leiter, Lawrence A; Jones, Charlotte; Ogilvie, Richard I; Woo, Vincent; McFarlane, Philip A; Hegele, Robert A; Tobe, Sheldon W
-risk patients in whom combination therapy is being considered, an ACE inhibitor plus a long-acting dihydropyridine CCB is preferable to an ACE inhibitor plus a thiazide diuretic. All hypertensive patients with dyslipidemia should be treated using the thresholds, targets and agents outlined in the Canadian lipid treatment guidelines. Selected patients with hypertension who do not achieve thresholds for statin therapy, but who are otherwise at high risk for cardiovascular events, should nonetheless receive statin therapy. Once blood pressure is controlled, low-dose acetylsalicylic acid therapy should be considered. VALIDATION: All recommendations were graded according to the strength of the evidence and voted on by the 63 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 80% consensus. These guidelines will continue to be updated annually. SPONSORS: The Canadian Hypertension Education Program process is sponsored by the Canadian Hypertension Society, Blood Pressure Canada, the Public Health Agency of Canada, the College of Family Physicians of Canada, the Canadian Pharmacists Association, the Canadian Council of Cardiovascular Nurses, and the Heart and Stroke Foundation of Canada. PMID:20485689
Macnab, A J; Radziminski, N; Budden, H; Kasangaki, A; Zavuga, R; Gagnon, F A; Mbabali, M
PROJECT GOAL: To adapt a successful Canadian health-promoting school initiative to a Ugandan context through international partnership. Rural children face many health challenges worldwide; health professionals in training understand these better through community-based learning. Aboriginal leaders in a Canadian First-Nations community identified poor oral health as a child health issue with major long-term societal impact and intervened successfully with university partners through a school-based program called "Brighter Smiles". Makerere University, Kampala, Uganda (MUK) sought to implement this delivery model for both the benefit of communities and the dental students. MUK identified rural communities where hospitals could provide dental students with community-based learning and recruited four local schools. A joint Ugandan and Canadian team of both trainees and faculty planned the program, obtained ethics consent and baseline data, initiated the Brighter Smiles intervention model (daily at-school tooth-brushing; in-class education), and recruited a cohort to receive additional bi-annual topical fluoride. Hurdles included: challenging international communication and planning due to inconsistent internet connections; discrepancies between Canadian and developing world concepts of research ethics and informed consent; complex dynamics for community engagement and steep learning curve for accurate data collection; an itinerant population at one school; and difficulties coordinating Canadian and Ugandan university schedules. Four health-promoting schools were established; teachers, children, and families were engaged in the initiative; community-based learning was adopted for the university students; quarterly team education/evaluation/service delivery visits to schools were initiated; oral health improved, and new knowledge and practices were evident; an effective international partnership was formed providing global health education, research and health care
Sidhu, Ravindar S.; Walker, G. Ross
Objectives To provide baseline data on resident continuity of care experience, to describe the effect of ambulatory centre surgery on continuity of care, to analyse continuity of care by level of resident training and to assess a resident-run preadmission clinic’s effect on continuity of care. Design Data were prospectively collected for 4 weeks. All patients who underwent a general surgical procedure were included if a resident was present at operation. Setting The Division of General Surgery, Queen’s University, Kingston, Ont. Outcome measures Preoperative, operative and inhospital postoperative involvement of each resident with each case was recorded. Results Residents assessed preoperatively (before entering the operating room) 52% of patients overall, 20% of patients at the ambulatory centre and 83% of patients who required emergency surgery. Of patients assessed by the chief resident, 94% were assessed preoperatively compared with 32% of patients assessed by other residents ( p 0.1). Conclusions This study serves as a reference for the continuity of care experience in Canadian surgical programs. Residents assessed only 52% of patients preoperatively, and only 40% of patients had complete continuity of care. Factors such as ambulatory surgery and junior level of training negatively affected continuity experience. Such factors must be taken into account in planning surgical education. PMID:10526519
Hanusaik, Nancy; Sabiston, Catherine M; Kishchuk, Natalie; Maximova, Katerina; O'Loughlin, Jennifer
In the context of the emerging field of public health services and systems research, this study (i) tested a model of the relationships between public health organizational capacity (OC) for chronic disease prevention, its determinants (organizational supports for evaluation, partnership effectiveness) and one possible outcome of OC (involvement in core chronic disease prevention practices) and (ii) examined differences in the nature of these relationships among organizations operating in more and less facilitating external environments. OC was conceptualized as skills and resources/supports for chronic disease prevention programming. Data were from a census of 210 Canadian public health organizations with mandates for chronic disease prevention. The hypothesized relationships were tested using structural equation modeling. Overall, the results supported the model. Organizational supports for evaluation accounted for 33% of the variance in skills. Skills and resources/supports were directly and strongly related to involvement. Organizations operating within facilitating external contexts for chronic disease prevention had more effective partnerships, more resources/supports, stronger skills and greater involvement in core chronic disease prevention practices. Results also suggested that organizations functioning in less facilitating environments may not benefit as expected from partnerships. Empirical testing of this conceptual model helps develop a better understanding of public health OC. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please email: firstname.lastname@example.org.
Li, Shuang; Ker, Alan P.
Research and observations indicate climate change has and will have an impact on Ontario field crop production. Little research has been done to forecast how climate change might influence the Canadian Federal-Provincial Crop Insurance program, including its premium rates and reserve fund balances, in the future decades. This paper proposes using a mixture of two normal yield probability distribution model to model crop yield conditions under hypothetical climate change scenarios. Then superi...
Khan, N A; McAlister, Finlay A; Rabkin, Simon W; Padwal, Raj; Feldman, Ross D; Campbell, Norman Rc; Leiter, Lawrence A; Lewanczuk, Richard Z; Schiffrin, Ernesto L; Hill, Michael D; Arnold, Malcolm; Moe, Gordon; Campbell, Tavis S; Herbert, Carol; Milot, Alain; Stone, James A; Burgess, Ellen; Hemmelgarn, B; Jones, Charlotte; Larochelle, Pierre; Ogilvie, Richard I; Houlden, Robyn; Herman, Robert J; Hamet, Pavel; Fodor, George; Carruthers, George; Culleton, Bruce; Dechamplain, Jacques; Pylypchuk, George; Logan, Alexander G; Gledhill, Norm; Petrella, Robert; Tobe, Sheldon; Touyz, Rhian M
proteinuria). Most adults with hypertension require more than one agent to achieve these target BPs. For adults without compelling indications for other agents, initial therapy should include thiazide diuretics. Other agents appropriate for first-line therapy for diastolic hypertension with or without systolic hypertension include beta-blockers (in those younger than 60 years), angiotensin-converting enzyme (ACE) inhibitors (in nonblack patients), long-acting calcium channel blockers or angiotensin receptor antagonists. Other agents for first-line therapy for isolated systolic hypertension include long-acting dihydropyridine calcium channel blockers or angiotensin receptor antagonists. Certain comorbid conditions provide compelling indications for first-line use of other agents: in patients with angina, recent myocardial infarction or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with diabetes mellitus, ACE inhibitors or angiotensin receptor antagonists (or in patients without albuminuria, thiazides or dihydropyridine calcium channel blockers) are appropriate first-line therapies; and in patients with nondiabetic chronic kidney disease, ACE inhibitors are recommended. All hypertensive patients should have their fasting lipids screened, and those with dyslipidemia should be treated using the thresholds, targets and agents recommended by the Canadian Hypertension Education Program Working Group on the management of dyslipidemia and the prevention of cardiovascular disease. Selected patients with hypertension, but without dyslipidemia, should also receive statin therapy and/or acetylsalicylic acid therapy. All recommendations were graded according to strength of the evidence and voted on by the 45 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 95% consensus. These guidelines will continue to be updated annually.
Khan, Nadia A; McAlister, Finlay A; Lewanczuk, Richard Z; Touyz, Rhian M; Padwal, Raj; Rabkin, Simon W; Leiter, Lawrence A; Lebel, Marcel; Herbert, Carol; Schiffrin, Ernesto L; Herman, Robert J; Hamet, Pavel; Fodor, George; Carruthers, George; Culleton, Bruce; DeChamplain, Jacques; Pylypchuk, George; Logan, Alexander G; Gledhill, Norm; Petrella, Robert; Campbell, Norman R C; Arnold, Malcolm; Moe, Gordon; Hill, Micharl D; Jones, Charlotte; Larochelle, Pierre; Ogilvie, Richard I; Tobe, Sheldon; Houlden, Robyn; Burgess, Ellen; Feldman, Ross D
damage and any comorbid conditions. Blood pressure should be lowered to 140/90 mmHg or less in all patients, and to 130/80 mmHg or less in those with diabetes mellitus or chronic kidney disease. Most adults with hypertension require more than one agent to achieve target blood pressures. For adults without compelling indications for other agents, initial therapy should include thiazide diuretics. Other agents appropriate for first-line therapy for diastolic hypertension with or without systolic hypertension include beta-blockers (in those younger than 60 years), angiotensin-converting enzyme (ACE) inhibitors (except in black patients), long-acting calcium channel blockers and angiotensin receptor antagonists. Other agents appropriate for first-line therapy for isolated systolic hypertension include long-acting dihydropyridine calcium channel blockers and angiotensin receptor antagonists. Certain comorbid conditions provide compelling indications for first-line use of other agents: in patients with angina, recent myocardial infarction or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with diabetes mellitus, ACE inhibitors or angiotensin receptor antagonists (or thiazides in patients with diabetes mellitus without albuminuria) are appropriate first-line therapies; and in patients with nondiabetic chronic kidney disease, ACE inhibitors are recommended. All hypertensive patients should have their fasting lipids screened, and those with dyslipidemia should be treated using the thresholds, targets and agents recommended by the Canadian Hypertension Education Program Working Group on the management of dyslipidemia and the prevention of cardiovascular disease. Selected patients with hypertension, but without dyslipidemia, should also receive statin therapy and/or acetylsalicylic acid therapy. All recommendations were graded according to the strength of the evidence and voted on by the 43 members of the Canadian Hypertension
Khan, Nadia A; Hemmelgarn, Brenda; Padwal, Raj; Larochelle, Pierre; Mahon, Jeff L; Lewanczuk, Richard Z; McAlister, Finlay A; Rabkin, Simon W; Hill, Michael D; Feldman, Ross D; Schiffrin, Ernesto L; Campbell, Norman R C; Logan, Alexander G; Arnold, Malcolm; Moe, Gordon; Campbell, Tavis S; Milot, Alain; Stone, James A; Jones, Charlotte; Leiter, Lawrence A; Ogilvie, Richard I; Herman, Robert J; Hamet, Pavel; Fodor, George; Carruthers, George; Culleton, Bruce; Burns, Kevin D; Ruzicka, Marcel; deChamplain, Jacques; Pylypchuk, George; Gledhill, Norm; Petrella, Robert; Boulanger, Jean-Martin; Trudeau, Luc; Hegele, Robert A; Woo, Vincent; McFarlane, Phil; Touyz, Rhian M; Tobe, Sheldon W
To provide updated, evidence-based recommendations for the prevention and management of hypertension in adults. For lifestyle and pharmacological interventions, evidence was reviewed from randomized controlled trials and systematic reviews of trials. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. However, for lifestyle interventions, blood pressure lowering was accepted as a primary outcome given the lack of long-term morbidity and mortality data in this field. For treatment of patients with kidney disease, the progression of kidney dysfunction was also accepted as a clinically relevant primary outcome. A Cochrane collaboration librarian conducted an independent MEDLINE search from 2005 to August 2006 to update the 2006 Canadian Hypertension Education Program recommendations. In addition, reference lists were scanned and experts were contacted to identify additional published studies. All relevant articles were reviewed and appraised independently by both content and methodological experts using prespecified levels of evidence. Dietary lifestyle modifications for prevention of hypertension, in addition to a well-balanced diet, include a dietary sodium intake of less than 100 mmol/day. In hypertensive patients, the dietary sodium intake should be limited to 65 mmol/day to 100 mmol/day. Other lifestyle modifications for both normotensive and hypertensive patients include: performing 30 min to 60 min of aerobic exercise four to seven days per week; maintaining a healthy body weight (body mass index of 18.5 kg/m2 to 24.9 kg/m2) and waist circumference (less than 102 cm in men and less than 88 cm in women); limiting alcohol consumption to no more than 14 units per week in men or nine units per week in women; following a diet reduced in saturated fat and cholesterol, and one that emphasizes fruits, vegetables and low-fat dairy products, dietary and soluble fibre, whole grains and protein from plant sources; and considering stress
Full Text Available Introduction: Inexperience, inadequate training and differential hazard exposure may contribute to a higher risk of injury in young workers. This study describes features of work-related injuries in young Canadians to identify areas for potential occupational injury prevention strategies. Methods: We analyzed records for youth aged 10–17 presenting to Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP emergency departments (EDs from 1991–2012. We classified work-related injuries into job groups corresponding to National Occupational Classification for Statistics 2006 codes and conducted descriptive analyses to assess injury profiles by job group. Age- and sex-adjusted proportionate injury ratios (PIRs and 95% confidence intervals (CIs were calculated to compare the nature of injuries between occupational and non-occupational events overall and by job group. Results: Of the 6046 injuries (0.72% of events in this age group that occurred during work, 63.9% were among males. Youth in food and beverage occupations (54.6% males made up 35.4% of work-related ED visits and 10.2% of work-related hospital admissions, while primary industry workers (76.4% males made up 4.8% of workrelated ED visits and 24.6% of work-related hospital admissions. PIRs were significantly elevated for burns (9.77, 95% CI: 8.94–10.67, crushing/amputations (6.72, 95% CI: 5.79–7.80, electrical injuries (6.04, 95% CI: 3.64–10.00, bites (5.09, 95% CI: 4.47–5.79, open wounds (2.68, 95% CI: 2.59–2.78 and eye injuries (2.50, 95% CI: 2.20–2.83 in occupational versus non-occupational events. These were largely driven by high proportional incidence of injury types unique to job groups. Conclusion: Our findings provide occupation group-specific information on common injury types that can be used to support targeted approaches to reduce incidence of youth injury in the workplace.
Pratt, B.; Cheesman, J.; Breslin, C.; Do, M. T.
Abstract Introduction: Inexperience, inadequate training and differential hazard exposure may contribute to a higher risk of injury in young workers. This study describes features of work-related injuries in young Canadians to identify areas for potential occupational injury prevention strategies. Methods: We analyzed records for youth aged 10–17 presenting to Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) emergency departments (EDs) from 1991–2012. We classified work-related injuries into job groups corresponding to National Occupational Classification for Statistics 2006 codes and conducted descriptive analyses to assess injury profiles by job group. Age- and sex-adjusted proportionate injury ratios (PIRs) and 95% confidence intervals (CIs) were calculated to compare the nature of injuries between occupational and non-occupational events overall and by job group. Results: Of the 6046 injuries (0.72% of events in this age group) that occurred during work, 63.9% were among males. Youth in food and beverage occupations (54.6% males) made up 35.4% of work-related ED visits and 10.2% of work-related hospital admissions, while primary industry workers (76.4% males) made up 4.8% of work-related ED visits and 24.6% of work-related hospital admissions. PIRs were significantly elevated for burns (9.77, 95% CI: 8.94–10.67), crushing/amputations (6.72, 95% CI: 5.79–7.80), electrical injuries (6.04, 95% CI: 3.64–10.00), bites (5.09, 95% CI: 4.47–5.79), open wounds (2.68, 95% CI: 2.59–2.78) and eye injuries (2.50, 95% CI: 2.20–2.83) in occupational versus non-occupational events. These were largely driven by high proportional incidence of injury types unique to job groups. Conclusion: Our findings provide occupation group-specific information on common injury types that can be used to support targeted approaches to reduce incidence of youth injury in the workplace. PMID:27172126
Hill, Janice; Freeman, Kate
Traditional educational practices of Indigenous Canadians were aimed at cultural transmission. All adults were responsible for educating the young, but because children stayed with the women until puberty, women played the most significant role in transmitting the culture. Adults with certain gifts and talents looked for similar attributes in…
This publication offers some insight into the problem of violence in Canadian schools and provides examples of ways to reduce it. The forms of violent activities examined include youth/youth-gang violence, violence against teachers, bullying, sexual harassment, and sexual assault. Each chapter presents research findings and examples of programs…
Khan, Nadia A; Hemmelgarn, Brenda; Herman, Robert J; Bell, Chaim M; Mahon, Jeff L; Leiter, Lawrence A; Rabkin, Simon W; Hill, Michael D; Padwal, Raj; Touyz, Rhian M; Larochelle, Pierre; Feldman, Ross D; Schiffrin, Ernesto L; Campbell, Norman R C; Moe, Gordon; Prasad, Ramesh; Arnold, Malcolm O; Campbell, Tavis S; Milot, Alain; Stone, James A; Jones, Charlotte; Ogilvie, Richard I; Hamet, Pavel; Fodor, George; Carruthers, George; Burns, Kevin D; Ruzicka, Marcel; DeChamplain, Jacques; Pylypchuk, George; Petrella, Robert; Boulanger, Jean-Martin; Trudeau, Luc; Hegele, Robert A; Woo, Vincent; McFarlane, Phil; Vallée, Michel; Howlett, Jonathan; Bacon, Simon L; Lindsay, Patrice; Gilbert, Richard E; Lewanczuk, Richard Z; Tobe, Sheldon
Cardiovascular Society position statement (recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease). Selected high-risk patients with hypertension who do not achieve thresholds for statin therapy according to the position paper should nonetheless receive statin therapy. Once blood pressure is controlled, acetylsalicylic acid therapy should be considered. All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 95% consensus. These guidelines will continue to be updated annually.
Khan, Nadia A; Hemmelgarn, Brenda; Herman, Robert J; Rabkin, Simon W; McAlister, Finlay A; Bell, Chaim M; Touyz, Rhian M; Padwal, Raj; Leiter, Lawrence A; Mahon, Jeff L; Hill, Michael D; Larochelle, Pierre; Feldman, Ross D; Schiffrin, Ernesto L; Campbell, Norman R C; Arnold, Malcolm O; Moe, Gordon; Campbell, Tavis S; Milot, Alain; Stone, James A; Jones, Charlotte; Ogilvie, Richard I; Hamet, Pavel; Fodor, George; Carruthers, George; Burns, Kevin D; Ruzicka, Marcel; dechamplain, Jacques; Pylypchuk, George; Petrella, Robert; Boulanger, Jean-Martin; Trudeau, Luc; Hegele, Robert A; Woo, Vincent; McFarlane, Phil; Vallée, Michel; Howlett, Jonathan; Katzmarzyk, Peter; Tobe, Sheldon; Lewanczuk, Richard Z
therapy. Once blood pressure is controlled, acetylsalicylic acid therapy should be considered. All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 95% consensus. These guidelines will continue to be updated annually.
Carla Abreu Ellis
Full Text Available Introduction This research investigated universities registered with the Association of Universities and Colleges of Canada (AUCC whose primary instructional language was English. A content analysis was performed on university web pages related to the following content: (a frequency of graduate programs being offered, (b types of degrees being offered, (c frequency and variation of program of study offerings, (d variation of exit requirements, and (e modalities of course delivery. This research provides an overview and analysis of graduate level programs, more precisely Masters and Doctorate degrees, offered through faculties of education in Canada. An understanding of the findings of this research may benefit Canadian university administrative bodies in providing a source in which they may compare findings with their current offerings and programming. Prospective students of graduate programs in education may also benefit from the information provided in this study when choosing a program of study by ameliorating their knowledge of current programs, curriculum offerings, and modes of course delivery being offered by faculties of education in Canada.
Filho, Geraldo Motta; Galvão, Marcus Vinicius; Monteiro, Martim; Cohen, Marcio; Brandão, Bruno
The study's objective is to evaluate the characteristics and problems of patients who underwent shoulder arthroplasties between July 2004 and November 2006. Methodology: During the period of the study, 145 shoulder arthroplasties were performed. A prospective protocol was used for every patient; demographic, clinical and surgical procedure data were collected. All gathered data were included in the data base. The patients were divided in three major groups: fractures, degenerative diseases and trauma sequels. Information obtained from the data base was correlated in order to determine patients' epidemiologic, injuries, and surgical procedure profiles. Results: Of the 145 shoulder arthroplasties performed, 37% presented trauma sequels, 30% degenerative diseases, and 33% proximal humerus fracture. 12% of the cases required total arthroplasties and 88% partial arthroplasties. Five major complications were observed on early postoperative period. Conclusion: Shoulder arthroplasties have become a common procedure in orthopaedic practice. Surgical records are important in evidencing progressive evolution and in enabling future clinical outcomes evaluation. PMID:26998463
Hyland, Meaghen; Ofner-Agostini, Marianna; Miller, Mark; Paton, Shirley; Gourdeau, Marie; Ishak, Magued
BACKGROUND: A 1996 preproject survey among Canadian Hospital Epidemiology Committee (CHEC) sites revealed variations in the prevention, detection, management and surveillance of Clostridium difficile-associated diarrhea (CDAD). Facilities wanted to establish national rates of nosocomially acquired CDAD (N-CDAD) to understand the impact of control or prevention measures, and the burden of N-CDAD on health care resources. The CHEC, in collaboration with the Laboratory Centre for Disease Control (Health Canada) and under the Canadian Nosocomial Infection Surveillance Program, undertook a prevalence surveillance project among selected hospitals throughout Canada. OBJECTIVE: To establish national prevalence rates of N-CDAD. METHODS: For six weeks in 1997, selected CHEC sites tested all diarrheal stools from inpatients for either C difficile toxin or C difficile bacteria with evidence of toxin production. Questionnaires were completed for patients with positive stool assays who met the case definitions. RESULTS: Nineteen health care facilities in eight provinces participated in the project. The overall prevalence of N-CDAD was 13.0% (95% CI 9.5% to 16.5%). The mean number of N-CDAD cases were 66.3 cases/100,000 patient days (95% CI 37.5 to 95.1) and 5.9 cases/1000 patient admissions (95% CI 3.4 to 8.4). N-CDAD was found most frequently in older patients and those who had been hospitalized for longer than two weeks in medical or surgical wards. CONCLUSIONS: This national prevalence surveillance project, which established N-CDAD rates, is useful as 'benchmark' data for Canadian health care facilities, and in understanding the patterns and impact of N-CDAD. PMID:18159321
Pinhas, Leora; Morris, Anne; Crosby, Ross D; Katzman, Debra K
To document and describe the incidence and age-specific presentation of early-onset restrictive eating disorders in children across Canada. Surveillance study. Cases were ascertained through the Canadian Paediatric Surveillance Program by surveying approximately 2453 Canadian pediatricians (a 95% participation rate) monthly during a 2-year period. Canadian pediatric practices. Pediatricians and pediatric subspecialists. A description of clinical presentations and characteristics of eating disorders in this population and the incidence of restrictive eating disorders in children. The incidence of early-onset restrictive eating disorders in children aged 5 to 12 years seen by pediatricians was 2.6 cases per 100 000 person-years. The ratio of girls to boys was 6:1, and 47.1% of girls and 54.5% of boys showed signs of growth delay. Forty-six percent of children were below the 10th percentile for body mass index, 34.2% were initially seen with unstable vital signs, and 47.2% required hospital admission. Only 62.1% of children met criteria for anorexia nervosa. Although children with anorexia nervosa were more likely to be medically compromised, some children who did not meet criteria for anorexia nervosa were equally medically unstable. Young children are seen with clinically significant restrictive eating disorders, with the incidence exceeding that of type 2 diabetes mellitus. These eating disturbances can result in serious medical consequences, ranging from growth delay to unstable vital signs, which can occur in the absence of weight loss or other restrictive eating disorder symptoms.
Chen, J.D.; Gerwing, A.F. [Channel Systems Inc., Pinawa MA (Canada); Maxwell, R. [Canadian Nuclear Safety Commission, Ottawa, ON (Canada); Larsson, M.; Axell, K.; Hildingsson, L. [Swedish Nuclear Power Inspectorate, Stockholm (Sweden); Lindberg, B. [LENS-TECH AB, Skellefteaa (Sweden); Sundkvist, E. [Teleca Design and Development, Stockholm (Sweden)
The Canadian and Swedish Safeguards Support Programs have developed a prototype Digital Cerenkov Viewing Device (DCVD) to verify spent fuel. Field measurements were conducted in January 2003 at the Swedish facilities CLAB and Ringhals Unit 2 on PWR fuel and non-fuel assemblies. The images obtained are documented and the Cerenkov characteristics observed are discussed. New Cerenkov information obtained offers the possibility of computer assisted verification of spent fuel and non-fuel assemblies. Quantitative analysis for parameters such as cooling time, alignment and Cerenkov glow as a function of distance are discussed.
Sellers, Elizabeth A C; Hadjiyannakis, Stasia; Amed, Shazhan; Dart, Allison B; Dyck, Roland F; Hamilton, Jill; Langlois, Valerie; Panagiotopoulos, Constadina; Dean, Heather J
To determine the prevalence and the clinical features associated with persistent albuminuria in Canadian children aged albuminuria in children with type 2 diabetes were reported during a 24-month period from 2010 to 2012. Persistent albuminuria was defined as an elevated albumin-to-creatinine ratio in a minimum of 2 out of 3 urine samples obtained at least 1 month apart over 3-6 months and confirmed with a first morning sample. Descriptive statistics were used to illustrate demographic and clinical features of the population. The prevalence of persistent albumuria was estimated using data from a previous national surveillence study of type 2 diabetes in children. Fifty cases were reported over the 24-month study period. The estimated prevalence of persistent albuminuria in children with type 2 diabetes in Canada was 5.1%. The median duration of diabetes at the time of diagnosis of albuminuria was 21 days (IQR, 0-241 days). Almost two-thirds (64%) were female, 80% were of Canadian First Nations heritage, and 76% were from Manitoba. Exposure to gestational or pregestational diabetes in utero occurred in 65%, and 48% had a family history of diabetes-related renal disease. Structural anomalies of the kidney were found in 37%. Persistent albuminuria occurs in youths with type 2 diabetes in the first year after diagnosis, demonstrates regional variation, and is associated with First Nations heritage and exposure to maternal diabetes during pregnancy. Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available This paper seeks to explore health literacies with a focus on public libraries and their patrons. The authors’ aim is to extract major themes, challenges, and recommendations for further research and collaboration between health professionals and information professionals in promoting health literacy skills to the public. Major issues will be discussed on the subjects of public service, education, and collaboration between health specialists and information specialists. A major focus of the paper is Canadian health literacy issues, as well as Canadian health information dissemination. Time constraints and budget cuts in the health care system have caused a major strain on health professionals. Within the system, there is a shortage of doctors, nurses, and time devoted to health literacy. As a result, patients often seek answers to their health concerns on their own and supplement their understanding of individual health issues by searching for information via the Internet. While consumers often seek answers to their health questions online, the lack of quality control on the Internet is problematic. Public librarians should therefore turn their attention to promoting and providing reliable online information. Meeting the needs of any group can be a challenge for information professionals in public libraries, especially when it comes to health literacy. Public libraries tend to be one of the first places of contact for general public inquiries on infectious diseases and emerging illnesses. Public librarians play an important role in their communities in all aspects of information research and therefore should be advocates for promoting proper health information.
Full Text Available This status report on the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP, an emergency department-based injury and poisoning surveillance system, describes the result of migrating from a centralized data entry and coding process to a decentralized process, the web-based eCHIRPP system, in 2011. This secure system is improving the CHIRPP’s overall flexibility and timeliness, which are key attributes of an effective surveillance system. The integrated eCHIRPP platform enables near real-time data entry and access, has user-friendly data management and analysis tools, and allows for easier communication and connectivity across the CHIRPP network through an online collaboration centre. Current pilot testing of automated data monitoring and trend analysis tools—designed to monitor and flag incoming data according to predefined criteria (for example, a new consumer product—is revealing eCHIRPP’s potential for providing early warnings of new hazards, issues and trends.
Muhling, Stefanie; Mady, Callie
This article describes a document analysis of policy and resource documents pertaining to inclusion of students with special education needs (SSEN) in Canadian French as a Second Language (FSL) programs. By recognizing gaps and acknowledging advancements, we aim to inform current implementation and future development of inclusive policy. Document…
van Gerwen, Marijke; Shaerf, Daniel A; Veen, Remmelt M
Hip resurfacing arthroplasty is claimed to allow higher activity levels and to give better quality of life than total hip arthroplasty. In this literature review, we assessed the therapeutic value of hip resurfacing arthroplasty as measured by functional outcome. An extensive literature search was performed using the PubMed, Embase, and Cochrane databases. 9 patient series, 1 case-control study, and 1 randomized controlled trial (RCT) were included. Clinically and statistically significant improvement in sporting activity and hip scores were found in 10 studies. Studies with low levels of evidence have shown improvement in various different hip scores and one RCT showed better outcomes with hip resurfacing arthroplasty. There is no high-level evidence to prove that there is improved clinical outcome using hip resurfacing arthroplasty. More randomized research needs to be done.
Bettinger, Julie A; Vanderkooi, Otto G; Scheifele, David W; Halperin, Scott A; Kellner, James D; Schryvers, Anthony; De Serres, Gaston; Alcantara, Joenel
The diversity of Canadian infant meningococcal C conjugate (MenC) vaccine programs is unique among countries providing MenC vaccines and offers a valuable opportunity to determine the optimal vaccine program. This longitudinal study assessed differences in seroprotection by 3 different vaccine schedules in children two years after receiving either 1 toddler MenC vaccine dose (1 dose), 1 infant and 1 toddler dose (2 doses), or 2 infant and 1 toddler MenC vaccine dose (3 doses). Three similar cohorts of healthy infants from 1, 2 and 3 dose program areas were enrolled before to their 12 month toddler dose and vaccinated with MenC-tetanus toxoid (MenC-TT) conjugate vaccine. Sera obtained 2 years later were assayed for serogroup C bactericidal activity using standardized procedures with rabbit as the exogenous complement source. Serum bactericidal activity titers ≥1:8 were considered protective. Results were available for 384 children. Rates of seroprotection at 36 months of age were significantly different between the 1 and 3 dose programs, but confidence intervals overlapped between the 1 and 2 dose programs and between the 2 and 3 dose programs: 1 dose 92% (95% confidence interval: 86%-96%) versus 99% (95%-100%) with 2 doses and 100% (97%-100%) with 3 doses. Geometric mean titers were significantly different at 12.1 (10.8-13.5), 32.4 (28.9-36.2) and 50.6 (45.7-55.9) in the 1, 2 and 3 dose programs, respectively. At 36 months of age, evidence of seroprotection remained for greater than 90% of participants. Our results indicate that 1 toddler dose or 1 infant plus 1 toddler dose with MenC-TT vaccine provides seroprotection against MenC disease in early childhood.
Wilson, Heather; Leydon, Joseph; Wincentak, Joanna
This paper investigates the prevalence of fieldwork in undergraduate Geography programs in Canada. It examines the presence of fieldwork, provided through both field courses and courses that include fieldwork components, by reviewing program requirements and course offerings in undergraduate geography programs. The research explores the extent to…
Mataseje, Laura F.; Abdesselam, Kahina; Vachon, Julie; Mitchel, Robyn; Bryce, Elizabeth; Roscoe, Diane; Boyd, David A.; Embree, Joanne; Katz, Kevin; Kibsey, Pamela; Simor, Andrew E.; Taylor, Geoffrey; Turgeon, Nathalie; Langley, Joanne; Gravel, Denise; Amaratunga, Kanchana
Carbapenemase-producing Enterobacteriaceae (CPE) are increasing globally; here we report on the investigation of CPE in Canada over a 5-year period. Participating acute care facilities across Canada submitted carbapenem-nonsusceptible Enterobacteriaceae from 1 January 2010 to 31 December 2014 to the National Microbiology Laboratory. All CPE were characterized by antimicrobial susceptibilities, pulsed-field gel electrophoresis, multilocus sequence typing, and plasmid restriction fragment length polymorphism analysis and had patient data collected using a standard questionnaire. The 5-year incidence rate of CPE was 0.09 per 10,000 patient days and 0.07 per 1,000 admissions. There were a total of 261 CPE isolated from 238 patients in 58 hospitals during the study period. blaKPC-3 (64.8%) and blaNDM-1 (17.6%) represented the highest proportion of carbapenemase genes detected in Canadian isolates. Patients who had a history of medical attention during international travel accounted for 21% of CPE cases. The hospital 30-day all-cause mortality rate for the 5-year surveillance period was 17.1 per 100 CPE cases. No significant increase in the occurrence of CPE was observed from 2010 to 2014. Nosocomial transmission of CPE, as well as international health care, is driving its persistence within Canada. PMID:27600052
Leadbeater, Bonnie J; Gladstone, Emilie J; Sukhawathanakul, Paweena
Substantial research illuminates many factors effecting the implementation of evidence-based mental health promotion programs in schools; however, research on how schools plan for sustaining their investments in these programs is limited. In this qualitative study, we elicited descriptions of opportunities and challenges for sustainability. We interviewed 24 individuals from schools involved in a longitudinal, qualitative research project that followed uptake and implementation of the evidence-based WITS Programs across 2 years (Leadbeater et al. 2012). WITS stands for Walk away, Ignore, Talk it out and Seek help and the online WITS Programs focus on preventing peer victimization ( www.witsprograms.ca ). Our findings suggest that sustainability planning in schools is not merely a next step following high quality implementation, but rather involves multiple ongoing processes that need to be anticipated and supported by school leadership and program champions and developers in order to realize investments in evidence-based programs.
Vehmeijer, Stephan B.W.; Husted, Henrik; Kehlet, Henrik
As a result of the introduction of fast-track programs, the length of hospital stay after arthroplasty has decreased to a point where some patients meet the discharge criteria on the day of surgery. In several studies, well-established fast-track centers have demonstrated the feasibility of outpa...
Baxendale Darlene M
Full Text Available Abstract Background Knowledge & attitudes of healthcare providers (HCP have significant impact on frequency with which vaccines are offered & accepted but many HCP are ill equipped to make informed recommendations about vaccine merits & risks. We performed an assessment of the educational needs of trainees regarding immunization and used the information thus ascertained to develop multi-faceted, evaluable, educational tools which can be integrated into formal education curricula. Methods (i A questionnaire was sent to all Canadian nursing, medical & pharmacy schools to assess immunization-related curriculum content (ii A 77-item web-based, validated questionnaire was emailed to final-year students in medicine, nursing, & pharmacy at two universities in Nova Scotia, Canada to assess knowledge, attitudes, & behaviors reflecting current immunization curriculum. Results The curriculum review yielded responses from 18%, 48%, & 56% of medical, nursing, & pharmacy schools, respectively. Time spent on immunization content varied substantially between & within disciplines from 50 hrs. Most schools reported some content regarding vaccine preventable diseases, immunization practice & clinical skills but there was considerable variability and fewer schools had learning objectives or formal evaluation in these areas. 74% of respondents didn't feel comfortable discussing vaccine side effects with parents/patients & only 21% felt they received adequate teaching regarding immunization during training. Conclusions Important gaps were identified in the knowledge of graduating nursing, medical, & pharmacy trainees regarding vaccine indications/contraindications, adverse events & safety. The national curriculum review revealed wide variability in immunization curriculum content & evaluation. There is clearly a need for educators to assess current curricula and adapt existing educational resources such as the Immunization Competencies for Health Professionals in
Gupta, Mona; Forlini, Cynthia; Lenton, Keith; Duchen, Raquel; Lohfeld, Lynne
The authors describe the hidden ethics curriculum in two postgraduate psychiatry programs. Researchers investigated the formal, informal, and hidden ethics curricula at two demographically different postgraduate psychiatry programs in Canada. Using a case study design, they compared three sources: individual interviews with residents and with faculty and a semi-structured review of program documents. They identified the formal, informal, and hidden curricula at each program for six ethics topics and grouped the topics under two thematic areas. They tested the applicability of the themes against the specific examples under each topic. Results pertaining to one of the themes and its three topics are reported here. Divergences occurred between the curricula for each topic. The nature of these divergences differed according to local program characteristics. Yet, in both programs, choices for action in ethically challenging situations were mediated by a minimum standard of ethics that led individuals to avoid trouble even if this meant their behavior fell short of the accepted ideal. Effective ethics education in postgraduate psychiatry training will require addressing the hidden curriculum. In addition to profession-wide efforts to articulate high-level values, program-specific action on locally relevant issues constitutes a necessary mechanism for handling the impact of the hidden curriculum.
Chen, J.D.; Gerwing, A.F. [Channel Systems Inc., Pinawa MA (Canada); Maxwell, R. [Canadian Nuclear Safety Commission, Ottawa, ON (Canada); Larsson, M.; Axell, K.; Hildingsson, L. [Swedish Nuclear Power Inspectorate, Stockholm (Sweden); Lindberg, B. [LENS-TECH AB, Skellefteaa (Sweden); Vinnaa, F. [Teleca Design and Development, Stockholm (Sweden)
The Canadian and Swedish Safeguards Support Programs have developed a new digital Cerenkov viewing device (DCVD) to verify spent fuel. The new system, based upon an electron-multiplied charge-coupled device that is lumogen coated, can operate at 14 frames per second using the fast 5 MHz analogue to digital converter. The new DCVD was successful in measuring the long-cooled Aagesta fuel with a burnup of 1,200 MWd/t U and a cooling time of 31 years, which is well below the target of 10,000 MWd/t U and 40- years- cooled. Scanning of fuel assemblies was successfully demonstrated. With the aid of a laser pointer system, random verification within a reasonable time frame was also demonstrated.
Chen, J.D.; Gerwing, A.F. [Channel Systems Inc., Pinawa MA (Canada); Maxwell, R. [Canadian Nuclear Safety Commission, Ottawa, ON (Canada); Larsson, M.; Axell, K.; Hildingsson, L. [Swedish Nuclear Power Inspectorate, Stockholm (Sweden); Lindberg, B. [LENS-TECH AB, Skellefteaa (Sweden); Sundkvist, E. [Teleca Design and Development, Stockholm (Sweden)
The Canadian and Swedish Safeguards Support Programs have developed a prototype Digital Cerenkov Viewing Device (DCVD) to verify spent fuel. Field measurements in Swedish nuclear power reactor fuel bays on BWR fuel and non-fuel assemblies resulted in new Cerenkov information that offers the possibility of computer-assisted verification of spent-fuel assemblies. A number of fuel assemblies with missing fuel rods were examined. The missing fuel rods are easily detected when not hidden under the lifting handle of the fuel assembly. Initial studies of off-angle viewing of these assemblies show promise for the detection of the missing fuel rods under the lifting handle. The quantitative nature of the charge-coupled device was examined. A number of procedures were developed to quantify parameters such as image intensity and alignment (collimation) of fuel and no fuel assemblies. The quantitative studies on fuel assembly intensity as a function of cooling time showed excellent agreement with the theoretical calculations.
Miller, Theodore T., E-mail: email@example.com [Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 (United States)
The imaging evaluation of the prosthetic hip begins with radiography, but arthrography, aspiration, scintigraphy, sonography, CT and MR imaging all have roles in the evaluation of the painful prosthesis. This article will review the appearance of normal hip arthroplasty including hemiarthroplasty, total arthroplasty, and hip resurfacing, as well as the appearances of potential complications such as aseptic loosening and osteolysis, dislocation, infection, periprosthetic fracture, hardware failure, and soft tissue abnormalities.
Cohen, Aaron; Schwartz, Hanit
The goal of this study was to propose and test a model of the determinants of the need for employees' assistance programs. The research model proposed six independent variables related to employees' assistance programs: organizational support, personal coping, negative spillover, occupational commitment, job satisfaction, and tenure. The model proposed that the relationship between the independent variables and the need for employees' assistance programs was not direct but was mediated by work-nonwork conflict and job stress. Questionnaires were mailed to employees of a school district in western Canada, and 300 usable questionnaires were returned, a response rate of 42%. The research model received modest support from the data. Some of the fit indices were not as strong as expected. On the other hand, the conceptual model was supported.
Letourneau, Nicole; Whitty, Pam; Watson, Barry; Phillips, Jennifer; Joschko, Justin; Gillis, Doris
Low levels of literacy in early childhood can have lasting effects on children's educational and intellectual development. Many countries have implemented newborn literacy programs designed to teach parents pre-literacy promoting activities to share with their children. We conducted 2 quasi-experimental studies using 1) a pre-test/post-test design and 2) a non-equivalent control group design to examine the effect of newborn literacy programs on parents' self-reported literacy intentions/behaviors, values toward literacy, and parent-child interactions. Parents were recruited from 3 provinces, 2 with newborn literacy programs (intervention) and 1 without (control). Parents in the intervention group completed prenatal and postnatal (after participation in program) questionnaires. Parents in the control group completed 1 questionnaire. Questionnaires were designed to capture parents' literacy intentions (prenatal), behaviors (postnatal), values, and parent-child interactions (postnatal). A total of 98 parents were included in study one and 174 were included in study two. Parents' self-reported prenatal intentions and values were higher than their postnatal behaviors and values. Parents in the intervention group exhibited higher literacy behaviors and values and greater enjoyment reading to their children than parents in the control group, though they also reported reading to their children less frequently. Parents in the intervention group had significantly higher Positive Interactive scores than controls. Overall, we found participation in newborn literacy programs positively impacted parenting behaviors and attitudes. Lower postnatal within-group scores (intentions and values versus behaviors and values) may have been the result of participants' high expectations. Given our findings, we recommend that these programs continue.
R. S. Padwal
Full Text Available Antiobesity pharmacotherapy and programs/providers that possess weight management expertise are not commonly used by physicians. The underlying reasons for this are not known. We performed a cross-sectional study in 33 Canadian medical practices (36 physicians examining 1788 overweight/obese adult patients. The frequency of pharmacotherapy use and referral for further diet, exercise, behavioral management and/or bariatric surgery was documented. If drug treatment or referral was not made, reasons were documented by choosing amongst preselected categories. Logistic regression models were used to identify predictors of antiobesity drug use. No single antiobesity management strategy was recommended by physicians in more than 50% of patients. Referral was most common for exercise (49% of cases followed by dietary advice (46%, and only 5% of eligible patients were referred for bariatric surgery. Significant predictors of initiating/continuing pharmacotherapy were male sex (OR 0.70; 95% CI 0.52–0.94, increasing BMI (1.02; 95% CI 1.01–1.03, and private drug coverage (1.78; 95% CI 1.39–2.29. “Not considered” and “patient refusal” were the main reasons for not initiating further weight management. We conclude that both physician and patient factors act as barriers to the use of weight management strategies and both need to be addressed to increase uptake of these interventions.
Dorofeev, Yu L; Ptashnikov, D A; Tkachenko, A N; Bakhtin, M Yu; Kalimullina, A F
The retrospective research analyzed the data of 893 patients undergoing total hip arthroplasty. There were used the data about patients undergoing hip arthroplasty without complications (the first group--808 cases) and patients with developed deep surgical site infection following total joint arthroplasty after 12 months (the second group--85 patients). It was applied as the training matrix in creation of mathematical prognosis and algorithm of prophylaxis of deep infection in patients undergoing the primary total hip arthroplasty. There were revealed 21 prognostic significant criteria of deep infection development in surgical site. The program was tested in prospective investigation (293 clinical cases) with follow-up term of 12 months after operation. The rate of development of postoperative deep infection in surgical wound reduced as compared with the rate in group of retrospective research from 1.7% to 0.7%. The efficacy of proposed program was 80%.
Mark J Kearns
Full Text Available BACKGROUND: There are limited recent data on rubella immunity in women of childbearing age in Canada. In the present paper, the proportion of rubella seroreactivity and redundant testing (testing of women previously seropositive when tested by the same physician in the Alberta prenatal rubella screening program were studied.
Teacher education programs play a crucial role in preparing teachers for their future assessment roles and responsibilities, yet many beginning teachers feel unprepared to assess their students' performances (Mertler, 2009). To address concerns related to the relevancy of pre-service assessment education, this study examined 57 syllabi from…
Benoit, Cecilia; Belle-Isle, Lynne; Smith, Michaela; Phillips, Rachel; Shumka, Leah; Atchison, Chris; Jansson, Mikael; Loppie, Charlotte; Flagg, Jackson
Social marginalization and criminalization create health and safety risks for sex workers and reduce their access to health promotion and prevention services compared to the general population. Community empowerment-based interventions that prioritize the engagement of sex workers show promising results. Peer-to-peer interventions, wherein sex workers act as educators of their colleagues, managers, clients and romantic partners, foster community mobilization and critical consciousness among sex workers and equip them to exercise agency in their work and personal lives. A pilot peer health education program was developed and implemented, with and for sex workers in one urban centre in Canada. To explore how the training program contributed to community empowerment and transformative learning among participants, the authors conducted qualitative interviews, asked participants to keep personal journals and to fill out feedback forms after each session. Thematic analysis was conducted on these three data sources, with emerging themes identified, organized and presented in the findings. Five themes emerged from the analysis. Our findings show that the pilot program led to reduced internalized stigma and increased self-esteem in participants. Participants' critical consciousness increased concerning issues of diversity in cultural background, sexual orientation, work experiences and gender identity. Participants gained knowledge about how sex work stigma is enacted and perpetuated. They also became increasingly comfortable challenging negative judgments from others, including frontline service providers. Participants were encouraged to actively shape the training program, which fostered positive relationships and solidarity among them, as well as with colleagues in their social network and with the local sex worker organization housing the program. Resources were also mobilized within the sex worker community through skills building and knowledge acquisition. The peer
Holm, Bente; Kristensen, Morten Tange; Myhrmann, Lis
To investigate the relationship between early functional mobility and pain intensity in a fast track program after total knee arthroplasty (TKA).......To investigate the relationship between early functional mobility and pain intensity in a fast track program after total knee arthroplasty (TKA)....
McKay, Carly; Prapavessis, Harry; Doherty, Timothy
To examine the effect of a 6-week prehabilitation exercise training program on presurgical quadriceps strength for patients undergoing total knee arthroplasty (TKA). Two-arm, parallel, randomized, controlled pilot trial. Private exercise space in a research facility. Twenty-two patients scheduled for primary TKA. Participants completed a series of baseline questionnaires (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Short Form 36, and Arthritis Self-efficacy Scale) and functional testing (isometric quadriceps strength assessment, flat-surface walk test, and stair ascent-descent test). The participants were randomized to a lower-body strength training program or to a nonspecific upper-body strength training program. The participants exercised 3 times per week for 6 weeks before TKA. Postintervention assessment occurred immediately before TKA, with follow-up assessments at 6 and 12 weeks after surgery. The primary outcome was isometric quadriceps strength. Secondary outcomes were mobility, pain, self-reported function, health-related quality of life, and arthritis self-efficacy. There was no significant treatment condition-by-time effect on quadriceps strength, but the effect size was large (F(3,18) = 0.89, P = .47, η(2) = 0.13). Similar findings were shown for walking speed (F(3,18) = 1.47, P = .26, η(2) = 0.20). There was a significant treatment-by-time effect for the Short Form 36 mental component score (F(3,18) = 0.41, P = .02, η(2) = 0.41), with differences emerging before surgery but not at either postoperative assessment. For all other secondary outcome measures, the treatment-by-time effect was nonsignificant and small. The intervention elicited clinically meaningful increases in quadriceps strength, walking speed, and mental health immediately before TKA. It did not impart lasting benefits to patients in the 12 weeks after surgery. Analysis of the results suggests that quadriceps strength may not drive functional improvements
Full Text Available Scientific background: The annual number of joint replacement operations in Germany is high. The introduction of an arthroplasty register promises an important contribution to the improvement of the quality of patient’s care. Research questions: The presented report addresses the questions on organization and functioning, benefits and cost-benefits as well as on legal, ethical and social aspects of the arthroplasty registers. Methods: A systematic literature search was conducted in September 2008 in the medical databases MEDLINE, EMBASE etc. and was complemented with a hand search. Documents describing arthroplasty registers and/or their relevance as well as papers on legal, ethical and social aspects of such registers were included in the evaluation. The most important information was extracted and analysed. Results: Data concerning 30 arthroplasty registers in 19 countries as well as one international arthroplasty register were identified. Most of the arthroplasty registers are maintained by national orthopedic societies, others by health authorities or by their cooperation. Mostly, registries are financially supported by governments and rarely by other sources.The participation of the orthopedists in the data collection process of the arthroplasty registry is voluntary in most countries. The consent of the patients is usually required. The unique patient identification is ensured in nearly all registers.Each data set consists of patient and clinic identification numbers, data on diagnosis, the performed intervention, the operation date and implanted prostheses. The use of clinical scores, patient-reported questionnaires and radiological documentation is rare. Methods for data documentation and transfer are paper form, electronic entry as well as scanning of the data using bar codes. The data are mostly being checked for their completeness and validity. Most registers offer results of the data evaluation to the treating orthopedists and
Cook, R A; O'Malley, M J
Ankle arthritis has traditionally been treated surgically with arthrodesis (fusion) after conservative measures have been exhausted. The success of joint arthroplasty in the knee, hip, and shoulder inspired many attempts over the past 30 years to construct a workable ankle prosthesis. The failures of first generation prostheses caused skepticism regarding the feasibility of total ankle arthroplasty (TAR), but the mistakes of the past have been transformed into improvements and modifications. Today's second generation total ankle designs show promise, and outcomes are encouraging. The Agility Ankle (DePuy, Warsaw, IN) designed by Dr. Frank Alvine is featured in this article. The method of implant and postoperative management are reviewed.
Shah, Nikhil; Reintjes, Frances; Courtney, Mark; Klarenbach, Scott W; Ye, Feng; Schick-Makaroff, Kara; Jindal, Kailash; Pauly, Robert P
Little is known about patients exiting home hemodialysis. We sought to characterize the reasons, clinical characteristics, and pre-exit health care team interactions of patients on home hemodialysis who died or underwent modality conversion (negative disposition) compared with prevalent patients and those who were transplanted (positive disposition). We conducted an audit of all consecutive patients incident to home hemodialysis from January of 2010 to December of 2014 as part of ongoing quality assurance. Records were reviewed for the 6 months before exit, and vital statistics were assessed up to 90 days postexit. Ninety-four patients completed training; 25 (27%) received a transplant, 11 (12%) died, and 23 (25%) were transferred to in-center hemodialysis. Compared with the positive disposition group, patients in the negative disposition group had a longer mean dialysis vintage (3.15 [SD=4.98] versus 1.06 [SD=1.16] years; P=0.003) and were performing conventional versus a more intensive hemodialysis prescription (23 of 34 versus 23 of 60; Pday mortality among patients undergoing modality conversion was 26%. Over a 6-year period, approximately one third of patients exited the program due to death or modality conversion. Patients who die or transfer to another modality have significantly higher health care resource utilization (e.g., hospitalization, respite treatments, nursing time, etc.). Copyright © 2017 by the American Society of Nephrology.
Leatherdale, Scott T.; Ahmed, Rashid
Data from the Canadian Youth Smoking Survey (n = 27,030 in 2006; n = 16,705 in 2004; n = 11,757 in 2002) were used to examine changes in the prevalence and comorbid use of alcohol, tobacco, and marijuana over time and examine if demographic factors and binge drinking are associated with comorbid substance use among youth. Alcohol was the most…
Full Text Available Background: Primary total elbow arthroplasty (TEA is a challenging procedure for orthopedic surgeons. It is not performed as frequently as compared to hip or knee arthroplasty. The elbow is a nonweight-bearing joint; however, static loading can create forces up to three times the body weight and dynamic loading up to six times. For elderly patients with deformity and ankylosis of the elbow due to posttraumatic arthritis or rheumatoid arthritis or comminuted fracture distal humerus, arthroplasty is one of the option. The aim of this study is to analyze the role of primary total elbow arthroplasty in cases of crippling deformity of elbow. Materials and Methods: We analyzed 11 cases of TEA, between December 2002 and September 2012. There were 8 females and 3 males. The average age was 40 years (range 30-69 years. The indications for TEA were rheumatoid arthritis, comminuted fracture distal humerus with intraarticular extension, and posttraumatic bony ankylosis of elbow joint. The Baksi sloppy (semi constrained hinge elbow prosthesis was used. Clinico-radiological followup was done at 1 month, 3 months, 6 months, 1 year, and then yearly basis. Results: In the present study, average supination was 70° (range 60-80° and average pronation was 70° (range 60-80°. Average flexion was 135° (range 130-135°. However, in 5 cases, there was loss of 15 to 35° (average 25° of extension (45° out of 11 cases. The mean Mayo elbow performance score was 95.4 points (range 70-100. Arm length discrepancy was only in four patients which was 36% out of 11 cases. Clinico-radiologically all the elbows were stable except in one case and no immediate postoperative complication was noted. Radiolucency or loosening of ulnar stem was seen in 2 cases (18% out of 11 cases, in 1 case it was noted after 5 years and in another after 10 years. In second case, revision arthroplasty was done, in which only ulnar hinge section, hinge screw and lock screw with hexagonal head
Full Text Available This paper explores the many and diverse factors that have driven changes to the field-based component of a program of teacher education in a large Canadian university over the past 10 years. We look at key contexts of influence to any work in program change; that of internal and external bodies at the institutional level, the operational or program delivery level, feedback from stakeholders in teacher education, and lastly, the research and scholarship in teacher education that provides a framework for innovation and improvement. A significant inclusion in this paper is the perspective on the support at ground level that is required, but rarely acknowledged, to move any change initiatives forward. We present models that capture a decade of change to 4 undergraduate field experiences and 2 graduate level internships that comprise the field component of our teacher education program. We share key indicators of success resulting from these changes, highlight important insights gleaned, and point to pressing challenges that we face as we look to future program evolution that will carry us into the next decade. While this work reflects one single field-based component of a teacher education program in Canada, we trust that useful parallels can be drawn by the reader as they contemplate or are in the process of addressing and moving through similar orbits of change and evolution within their own programs.
Full Text Available Abstract This study aimed to determine the appropriate IELTS band scores in Writing and Speaking for admission to and success in Computer Systems Technology (CST and Computer Information Technology (CIT programs at a large Canadian polytechnic post-secondary institute. A second aim was to explore whether the quality of admissions decisions could be enhanced by aligning their processes more closely with the English language demands of actual tasks required within their target programs. This was done by examining course materials, activities, and assignments in which students are required to read, write, speak, and listen in English and then comparing the required proficiency in English for those tasks to band score descriptors provided by the IELTS measure. Data consisted of student interviews, faculty interviews, observations of lectures and labs, and course documents. Because of the small number of interviewees and the limited depth and scope of content analysis, results should be viewed as indicative rather than conclusive.
Babazadeh, Sina; Stoney, James D.; Lim, Keith; Choong, Peter F.M.
The Charcot knee - or neuropathic arthropathy - presents a considerable challenge to the orthopaedic surgeon. Caused by a combination of sensory, motor and autonomic neuropathy, it was originally described as an arthritic sequelae of neurosyphilis. In today's western orthopaedics it is more often caused by diabetes. A Charcot knee is often symptomatically painful and unstable. Traditional management has usually been conservative or arthrodesis, with limited success. Arthroplasty of a Charcot joint has commonly been avoided at all costs. However, in the right patient, using the right technique, arthroplasty can significantly improve the symptoms of a Charcot joint. This article explores the evidence surrounding the role of arthroplasty in the management of a Charcot knee. Arthroplasty is compared to other forms of treatment and specific patient demographics and surgical techniques are explored in an attempt to define the role of arthroplasty in the management of a Charcot knee. PMID:21808708
Full Text Available The Charcot knee - or neuropathic arthropathy - presents a considerable challenge to the orthopaedic surgeon. Caused by a combination of sensory, motor and autonomic neuropathy, it was originally described as an arthritic sequelae of neurosyphilis. In today’s western orthopaedics it is more often caused by diabetes. A Charcot knee is often symptomatically painful and unstable. Traditional management has usually been conservative or arthrodesis, with limited success. Arthroplasty of a Charcot joint has commonly been avoided at all costs. However, in the right patient, using the right technique, arthroplasty can significantly improve the symptoms of a Charcot joint. This article explores the evidence surrounding the role of arthroplasty in the management of a Charcot knee. Arthroplasty is compared to other forms of treatment and specific patient demographics and surgical techniques are explored in an attempt to define the role of arthroplasty in the management of a Charcot knee.
Vernon H Hoeppner
Full Text Available Endemic tuberculosis (TB was almost certainly present in Canadian aboriginal people (aboriginal Canadians denotes status Indians, Inuit, nonstatus Indians and metis as reported by Statistics Canada before the Old World traders arrived. However, the social changes that resulted from contact with these traders created the conditions that converted endemic TB into epidemic TB. The incidence of TB varied inversely with the time interval from this cultural collision, which began on the east coast in the 16th century and ended in the Northern Territories in the 20th century. This relatively recent epidemic explains why the disease is more frequent in aboriginal children than in Canadian-born nonaboriginal people. Treatment plans must account for the socioeconomic conditions and cultural characteristics of the aboriginal people, especially healing models and language. Prevention includes bacillus Calmette-Guerin vaccination and chemoprophylaxis, and must account for community conditions, such as rates of suicide, which have exceeded the rate of TB. The control of TB requires a centralized program with specifically directed funding. It must include a program that works in partnership with aboriginal communities.
"I Am Canadian: Immigration and Multiculturalism in the True North" looks at Canadian immigration history from a contemporary point of view. The article scrutinizes recent discussions on dual nationality and what this may mean for Canadianness......."I Am Canadian: Immigration and Multiculturalism in the True North" looks at Canadian immigration history from a contemporary point of view. The article scrutinizes recent discussions on dual nationality and what this may mean for Canadianness....
de Toledo, Joelly Mahnic; Loss, Jefferson Fagundes; Janssen, Thomas W.; van der Scheer, Jan W.; Alta, Tjarco D.; Willems, W. Jaap; Veeger, DirkJan (H. E. J)
Background: Following shoulder arthroplasty, any well-planned rehabilitation program should include muscle strengthening. However, it is not always clear how different external loads influence shoulder kinematics in patients with shoulder prostheses. The objective of this study was to describe
Schrøder, Henrik M.; Petersen, Michael M.
Total knee arthroplasty (TKA) is a successful treatment of the osteoarthritic knee, which has increased dramatically over the last 30 years. The indication is a painful osteoarthritic knee with relevant radiographic findings and failure of conservative measures like painkillers and exercise...... surgeon seems to positively influence the rate of surgical complications and implant survival. The painful TKA knee should be thoroughly evaluated, but not revised except if a relevant indication can be established. The most frequent indications for revision are: aseptic loosening, instability, infection...
Schrøder, Henrik M.; Petersen, Michael M.
Total knee arthroplasty (TKA) is a successful treatment of the osteoarthritic knee, which has increased dramatically over the last 30 years. The indication is a painful osteoarthritic knee with relevant radiographic findings and failure of conservative measures like painkillers and exercise......, and - at least in the younger patients - more cementless implants. Trends related to organization are implementation of the fast track concept, which has reduced morbidity and length of stay, and concentration in larger units, which will also decrease morbidity and mortality. An annual volume of >25 TKAs per...
Kehlet, Henrik; Thienpont, Emmanuel
Fast-track programs have been developed for different surgical procedures leading to higher patient satisfaction and lower morbidity. This concept has been extended to knee arthroplasty in recent years. The purpose of this narrative review was to discuss the different aspects of fast-track knee...
Deepa P., Rao; Minh T., Do; Jennifer, Crain; Steven, McFaull; Rebecca, Stranberg; Teresa, Mersereau; Wendy, Thompson
Abstract A barbecue (BBQ) brush is a common household item designed for cleaning grills used for barbecuing. Data from the electronic Canadian Hospitals Injury Reporting and Prevention Program database were analysed to estimate the frequency of injuries related to BBQ brushes as a proportion of all injuries, as well as to describe characteristics associated with such injury events. Between April 1, 2011 and July 17, 2017, BBQ brush injuries were observed at a frequency of 1.5 cases per 100 000 eCHIRPP cases (N = 12). Findings suggest that in addition to risks associated with the ingestion of loose BBQ brush bristles attached to foods, loose bristles could also result in injury via other mechanisms. PMID:29043764
Sallaberger, Christian; Space Plan Task Force, Canadian Space Agency
The Canadian Space Agency has chosen space robotics as one of its key niche areas, and is currently preparing to deliver the first flight elements for the main robotic system of the international space station. The Mobile Servicing System (MSS) is the Canadian contribution to the international space station. It consists of three main elements. The Space Station Remote Manipulator System (SSRMS) is a 7-metre, 7-dof, robotic arm. The Special Purpose Dextrous Manipulator (SPDM), a smaller 2-metre, 7-dof, robotic arm can be used independently, or attached to the end of the SSRMS. The Mobile Base System (MBS) will be used as a support platform and will also provide power and data links for both the SSRMS and the SPDM. A Space Vision System (SVS) has been tested on Shuttle flights, and is being further developed to enhance the autonomous capabilities of the MSS. The CSA also has a Strategic Technologies in Automation and Robotics Program which is developing new technologies to fulfill future robotic space mission needs. This program is currently developing in industry technological capabilities in the areas of automation of operations, autonomous robotics, vision systems, trajectory planning and object avoidance, tactile and proximity sensors, and ground control of space robots. Within the CSA, a robotic testbed and several research programs are also advancing technologies such as haptic devices, control via head-mounted displays, predictive and preview displays, and the dynamic characterization of robotic arms. Canada is also now developing its next Long Term Space Plan. In this context, a planetary exploration program is being considered, which would utilize Canadian space robotic technologies in this new arena.
Understanding the performance and impact of public knowledge translation funding interventions: protocol for an evaluation of Canadian Institutes of Health Research knowledge translation funding programs.
McLean, Robert K D; Graham, Ian D; Bosompra, Kwadwo; Choudhry, Yumna; Coen, Stephanie E; Macleod, Martha; Manuel, Christopher; McCarthy, Ryan; Mota, Adrian; Peckham, David; Tetroe, Jacqueline M; Tucker, Joanne
The Canadian Institutes of Health Research (CIHR) has defined knowledge translation (KT) as a dynamic and iterative process that includes the synthesis, dissemination, exchange, and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products, and strengthen the healthcare system. CIHR, the national health research funding agency in Canada, has undertaken to advance this concept through direct research funding opportunities in KT. Because CIHR is recognized within Canada and internationally for leading and funding the advancement of KT science and practice, it is essential and timely to evaluate this intervention, and specifically, these funding opportunities. The study will employ a novel method of participatory, utilization-focused evaluation inspired by the principles of integrated KT. It will use a mixed methods approach, drawing on both quantitative and qualitative data, and will elicit participation from CIHR funded researchers, knowledge users, KT experts, as well as other health research funding agencies. Lines of inquiry will include an international environmental scan, document/data reviews, in-depth interviews, targeted surveys, case studies, and an expert review panel. The study will investigate how efficiently and effectively the CIHR model of KT funding programs operates, what immediate outcomes these funding mechanisms have produced, and what impact these programs have had on the broader state of health research, health research uptake, and health improvement. The protocol and results of this evaluation will be of interest to those engaged in the theory, practice, and evaluation of KT. The dissemination of the study protocol and results to both practitioners and theorists will help to fill a gap in knowledge in three areas: the role of a public research funding agency in facilitating KT, the outcomes and impacts KT funding interventions, and how KT can best be evaluated.
Understanding the performance and impact of public knowledge translation funding interventions: Protocol for an evaluation of Canadian Institutes of Health Research knowledge translation funding programs
McLean Robert K D
Full Text Available Abstract Background The Canadian Institutes of Health Research (CIHR has defined knowledge translation (KT as a dynamic and iterative process that includes the synthesis, dissemination, exchange, and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products, and strengthen the healthcare system. CIHR, the national health research funding agency in Canada, has undertaken to advance this concept through direct research funding opportunities in KT. Because CIHR is recognized within Canada and internationally for leading and funding the advancement of KT science and practice, it is essential and timely to evaluate this intervention, and specifically, these funding opportunities. Design The study will employ a novel method of participatory, utilization-focused evaluation inspired by the principles of integrated KT. It will use a mixed methods approach, drawing on both quantitative and qualitative data, and will elicit participation from CIHR funded researchers, knowledge users, KT experts, as well as other health research funding agencies. Lines of inquiry will include an international environmental scan, document/data reviews, in-depth interviews, targeted surveys, case studies, and an expert review panel. The study will investigate how efficiently and effectively the CIHR model of KT funding programs operates, what immediate outcomes these funding mechanisms have produced, and what impact these programs have had on the broader state of health research, health research uptake, and health improvement. Discussion The protocol and results of this evaluation will be of interest to those engaged in the theory, practice, and evaluation of KT. The dissemination of the study protocol and results to both practitioners and theorists will help to fill a gap in knowledge in three areas: the role of a public research funding agency in facilitating KT, the outcomes and impacts KT funding
Elharram, Malik; Dinh, Trish; Lalande, Annie; Ge, Susan; Gao, Sophie; Noël, Geoffroy
As health care delivery increasingly requires providers to cross international borders, medical students at McGill University, Canada, developed a multidirectional exchange program with Haiti and Rwanda. The program integrates surgery, pathology, anatomy, research methodology, and medical education. The aim of the present study was to explore the global health value of this international training program to improve medical education within the environment of developing countries, such as Haiti and Rwanda, while improving sociocultural learning of Canadian students. Students from the University of Kigali, Rwanda and Université Quisqueya, Haiti, participated in a 3-week program at McGill University. The students spanned from the first to sixth year of their respective medical training. The program consisted of anatomy dissections, surgical simulations, clinical pathology shadowing, and interactive sessions in research methodology and medical education. To evaluate the program, a survey was administered to students using a mixed methodology approach. Common benefits pointed out by the participants included personal and professional growth. The exchange improved career development, sense of responsibility toward one's own community, teaching skills, and sociocultural awareness. The participants all agreed that the anatomy dissections improved their knowledge of anatomy and would make them more comfortable teaching the material when the returned to their university. The clinical simulation activities and shadowing experiences allowed them to integrate the different disciplines. However, the students all felt the research component had too little time devoted to it and that the knowledge presented was beyond their educational level. The development of an integrated international program in surgery, pathology, anatomy, research methodology, and medical education provided medical students with an opportunity to learn about differences in health care and medical education
Anderson, David R; Dunbar, Michael; Murnaghan, John; Kahn, Susan R; Gross, Peter; Forsythe, Michael; Pelet, Stephane; Fisher, William; Belzile, Etienne; Dolan, Sean; Crowther, Mark; Bohm, Eric; MacDonald, Steven J; Gofton, Wade; Kim, Paul; Zukor, David; Pleasance, Susan; Andreou, Pantelis; Doucette, Steve; Theriault, Chris; Abianui, Abongnwen; Carrier, Marc; Kovacs, Michael J; Rodger, Marc A; Coyle, Doug; Wells, Philip S; Vendittoli, Pascal-Andre
Clinical trials and meta-analyses have suggested that aspirin may be effective for the prevention of venous thromboembolism (proximal deep-vein thrombosis or pulmonary embolism) after total hip or total knee arthroplasty, but comparisons with direct oral anticoagulants are lacking for prophylaxis beyond hospital discharge. We performed a multicenter, double-blind, randomized, controlled trial involving patients who were undergoing total hip or knee arthroplasty. All the patients received once-daily oral rivaroxaban (10 mg) until postoperative day 5 and then were randomly assigned to continue rivaroxaban or switch to aspirin (81 mg daily) for an additional 9 days after total knee arthroplasty or for 30 days after total hip arthroplasty. Patients were followed for 90 days for symptomatic venous thromboembolism (the primary effectiveness outcome) and bleeding complications, including major or clinically relevant nonmajor bleeding (the primary safety outcome). A total of 3424 patients (1804 undergoing total hip arthroplasty and 1620 undergoing total knee arthroplasty) were enrolled in the trial. Venous thromboembolism occurred in 11 of 1707 patients (0.64%) in the aspirin group and in 12 of 1717 patients (0.70%) in the rivaroxaban group (difference, 0.06 percentage points; 95% confidence interval [CI], -0.55 to 0.66; Paspirin group and in 5 (0.29%) in the rivaroxaban group (difference, 0.18 percentage points; 95% CI, -0.65 to 0.29; P=0.42). Clinically important bleeding occurred in 22 patients (1.29%) in the aspirin group and in 17 (0.99%) in the rivaroxaban group (difference, 0.30 percentage points; 95% CI, -1.07 to 0.47; P=0.43). Among patients who received 5 days of rivaroxaban prophylaxis after total hip or total knee arthroplasty, extended prophylaxis with aspirin was not significantly different from rivaroxaban in the prevention of symptomatic venous thromboembolism. (Funded by the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT01720108 .).
Degree of vertical integration between the undergraduate program and clinical internship with respect to lumbopelvic diagnostic and therapeutic procedures taught at the canadian memorial chiropractic college.
Vermet, Shannon; McGinnis, Karen; Boodham, Melissa; Gleberzon, Brian J
The objective of this study was to determine to what extent the diagnostic and therapeutic procedures taught in the undergraduate program used for patients with lumbopelvic conditions are expected to be utilized by students during their clinical internship program at Canadian Memorial Chiropractic College or are being used by the clinical faculty. A confidential survey was distributed to clinical faculty at the college. It consisted of a list of diagnostic and therapeutic procedures used for lumbopelvic conditions taught at that college. Clinicians were asked to indicate the frequency with which they performed or they required students to perform each item. Seventeen of 23 clinicians responded. The following procedures were most likely required to be performed by clinicians: posture; ranges of motion; lower limb sensory, motor, and reflex testing; and core orthopedic tests. The following were less likely to be required to be performed: Waddell testing, Schober's test, Gillet tests, and abdominal palpation. Students were expected to perform (or clinicians performed) most of the mobilization (in particular, iliocostal, iliotransverse, and iliofemoral) and spinal manipulative therapies (in particular, the procedures referred to as the lumbar roll, lumbar pull/hook, and upper sacroiliac) taught at the college. This study suggests that there was considerable, but not complete, vertical integration between the undergraduate and clinical education program at this college.
Degree of vertical integration between the undergraduate program and clinical internship with respect to cervical and cranial diagnostic and therapeutic procedures taught at the canadian memorial chiropractic college.
Leppington, Charmody; Gleberzon, Brian; Fortunato, Lisa; Doucet, Nicolea; Vandervalk, Kyle
The purpose of this study was to determine if diagnostic and therapeutic procedures for the cervical and cranial spine taught to students during the undergraduate program at Canadian Memorial Chiropractic College are required to be used during their internship by their supervising clinicians and, if so, to what extent these procedures are used. Course manuals and course syllabi from the Applied Chiropractic and Clinical Diagnosis faculty of the undergraduate chiropractic program for the academic year 2009-2010 were consulted and a list of all diagnostic and therapeutic procedures for the cranial and cervical spine was compiled. This survey asked clinicians to indicate if they themselves used or if they required the students they were supervising to use each procedure listed and, if so, to what extent each procedure was used. Demographic information of each clinician was also obtained. In general, most diagnostic procedures of the head and neck were seldom used, with the exception of postural observation and palpation. By contrast, most cervical orthopaedic tests were often used, with the exception of tests for vertigo. Most therapeutic procedures were used frequently with the exception of prone cervical and "muscle" adjustments. There was a low degree of vertical integration for cranial procedures as compared to a much higher degree of vertical integration for cervical procedures between the undergraduate and clinical internship programs taught. Vertical integration is an important element of curricular planning and these results may be helpful to aid educators to more appropriately allocate classroom instruction.
Bilingual language education in Canada comprises Bilingual Programs in minority languages and programs in official languages (e.g., French immersion). However, pedagogy in Bilingual Programs has not been studied to the same depth as it has been in French Immersion, so little is known about the teaching practices within them. Immersion pedagogy,…
Roberts, Timothy T; Filler, Ryan J; Savage, Jason W; Benzel, Edward C
In the United States, cervical total disk arthroplasty (TDA) is US Federal Drug Administration (FDA) approved for use in both 1 and 2-level constructions for cervical disk disease resulting in myelopathy and/or radiculopathy. TDA designs vary in form, function, material composition, and even performance in?vivo. However, the therapeutic goals are the same: to remove the painful degenerative/damaged elements of the intervertebral discoligamenous joint complex, to preserve or restore the natural range of spinal motion, and to mitigate stresses on adjacent spinal segments, thereby theoretically limiting adjacent segment disease (ASDis). Cervical vertebrae exhibit complex, coupled motions that can be difficult to artificially replicate. Commonly available TDA designs include ball-and-socket rotation-only prostheses, ball-and-trough rotation and anterior-posterior translational prostheses, as well as unconstrained elastomeric disks that can rotate and translate freely in all directions. Each design has its respective advantages and disadvantages. At this time, available clinical evidence does not favor 1 design philosophy over another. The superiority of cervical TDA over the gold-standard anterior cervical discectomy and fusion is a subject of great controversy. Although most studies agree that cervical TDA is at least as effective as anterior cervical discectomy and fusion at reducing or eliminating preoperative pain and neurological symptoms, the clinical benefits of motion preservation- that is, reduced incidence of ASDis-are far less clear. Several short-to-mid-term studies suggest that disk arthroplasty reduces the radiographic incidence of adjacent segment degeneration; however, the degree to which this is clinically significant is disputed. At this time, TDA has not been clearly demonstrated to reduce symptomatic?ASDis.
Aronson, Ronnie; Goldenberg, Ronald; Boras, Damir; Skovgaard, Rasmus; Bajaj, Harpreet
The true prevalence of hypoglycemia in insulin-treated patients with diabetes and its impact on patients, employers and healthcare providers is poorly appreciated owing to a paucity of real-world data. The global Hypoglycemia Assessment Tool (HAT) study addressed this issue, and here we report data from the Canadian cohort of patients. This noninterventional, 6-month retrospective and 4-week prospective study enrolled patients aged ≥18 years receiving insulin treatment for >12 months from community endocrinology practices. Data were collected using self-assessment questionnaires and patient diaries. The primary endpoint was the proportion of patients experiencing ≥1 hypoglycemic event during the 4-week prospective observational period. Four hundred ninety-eight patients with type 1 diabetes (n=183) and type 2 diabetes (n=315) were enrolled. The prevalence of hypoglycemia was similar in the retrospective (type 1 diabetes, 92.3%; type 2 diabetes, 63.5%) and prospective (type 1 diabetes, 95.2%; type 2 diabetes, 64.2%) periods. Prospective rates of any, nocturnal and severe hypoglycemia per patient-year (95% confidence interval) were 69.3 (66.4; 72.2), 14.2 (12.9; 15.6) and 1.8 [1.4; 2.4]. Higher rates were reported retrospectively, reaching significance for nocturnal hypoglycemia per patient-year (30.0 [28.1; 32.0] vs. 14.2 [12.9; 15.6]; pinsulin doses) and increased blood glucose self-monitoring. Prevalence and incidence of hypoglycemia were high among insulin-treated patients with diabetes in Canada, and some patients took harmful or costly actions when they experienced hypoglycemia. Identifying the insulin-treated patients who are at greatest risk may help to reduce the incidence of hypoglycemia. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.
Page, D; Crymble, S; Lawday, K; Long, M; Stoffman, J; Waterhouse, L; Wilton, P
A network of 25 haemophilia/inherited bleeding disorder comprehensive care centres was established in Canada in the 1970s and 1980s. In 2007, standards of care, focused on the structural and resource requirements necessary to effectively provide optimal care, were adopted. Assess how human and physical resources affect centres' capacity to attain standards of care. The Canadian Hemophilia Society (CHS), with the support of the Association of Hemophilia Clinic Directors of Canada (AHCDC), undertook the assessment. Health care providers were interviewed in person by lay CHS volunteers and staff. A comprehensive patient satisfaction survey was mailed to a representative cross-section of patients/caregivers. The CHS observed that, despite competent and dedicated staff, many of the programmes are experiencing serious resource deficiencies. Twenty-three of the 25 programmes lack resources in one or more of the following disciplines: haematology, nursing, physiotherapy, social work and clerical/data entry. In nine of the 25 programmes, no resources are allocated to certain core disciplines, notably physiotherapy and social work. Key standards of care, including regular health assessments and close monitoring of home infusion with factor concentrates, are not always respected. Nevertheless, a high level of satisfaction was observed among patients and their caregivers. The study also discovered that clotting factor concentrates constitute 90-95% of the total cost of care while all other aspects of care delivery represent only 5-10%. Under-funding of programmes and suboptimal monitoring of valuable clotting factor concentrate utilization and reporting are both 'penny-wise' and 'pound-foolish'. A formal accreditation process is needed. © 2016 John Wiley & Sons Ltd.
Bonutti, Peter M; Mont, Michael A; McMahon, Margo; Ragland, Phillip S; Kester, Mark
Currently, minimally invasive total knee arthroplasty is defined as an incision length of definition are: 1. The amount of soft-tissue dissection (including muscle, ligament, and capsular damage). 2. Patellar retraction or eversion. 3. Tibiofemoral dislocation. Minimally invasive surgery should not be considered to be a cosmetic procedure but rather one that addresses patients' concerns with regard to postoperative pain and slow rehabilitation. Standard total knee arthroplasties provide pain relief, but returning to activities of daily living remains a challenge for some individuals, who may take several weeks to recover. Several studies have demonstrated long-term success (at more than ten years) of standard total knee arthroplasties. However, many patients remain unsatisfied with the results of the surgery. In a study of functional limitations of patients with a Knee Society score of > or = 90 points after total knee arthroplasty, only 35% of patients stated that they had no limitations. This finding was highlighted in a study by Dickstein et al., in which one-third of the elderly patients who underwent knee replacement were unhappy with the outcome at six and twelve months postoperatively. Although many surgeons utilize objective functional scoring systems to evaluate outcome, it is likely that the criteria for a successful result of total knee arthroplasty differ between the patient and the surgeon. This was evident in a report by Bullens et al., who concluded that surgeons are more satisfied with the results of total knee arthroplasty than are their patients. Trousdale et al. showed that, in addition to concerns about long-term functional outcome, patients' major concerns were postoperative pain and the time required for recovery. Patients undergoing total knee arthroplasty have specific functional goals, such as climbing stairs, squatting, kneeling, and returning to some level of low-impact sports after surgery. Our clinical investigations demonstrated that
Skivington, Kathryn; Lifshen, Marni; Mustard, Cameron
Comprehensive workplace return-to-work policies, applied with consistency, can reduce length of time out of work and the risk of long-term disability. This paper reports on the findings from a qualitative study exploring managers' and return-to-work-coordinators' views on the implementation of their organization's new return-to-work program. To provide practical guidance to organizations in designing and implementing return-to-work programs for their employees. Semi-structured qualitative interviews were undertaken with 20 managers and 10 return-to-work co-ordinators to describe participants' perspectives on the progress of program implementation in the first 18 months of adoption. The study was based in a large healthcare organization in Ontario, Canada. Thematic analysis of the data was conducted. We identified tensions evident in the early implementation phase of the organization's return-to-work program. These tensions were attributed to uncertainties concerning roles and responsibilities and to circumstances where objectives or principles appeared to be in conflict. The implementation of a comprehensive and collaborative return-to-work program is a complex challenge. The findings described in this paper may provide helpful guidance for organizations embarking on the development and implementation of a return-to-work program.
Lafrenière-Bérubé, Charles; Chouteau, Michel; Shamsipour, Pejman; Olivo, Gema R.
Spectral induced polarization (SIP) parameters can be extracted from field or laboratory complex resistivity measurements, and even airborne or ground frequency domain electromagnetic data. With the growing interest in application of complex resistivity measurements to environmental and mineral exploration problems, there is a need for accurate and easy-to-use inversion tools to estimate SIP parameters. These parameters, which often include chargeability and relaxation time may then be studied and related to other rock attributes such as porosity or metallic grain content, in the case of mineral exploration. We present an open source program, available both as a standalone application or Python module, to estimate SIP parameters using Markov-chain Monte Carlo (MCMC) sampling. The Python language is a high level, open source language that is now widely used in scientific computing. Our program allows the user to choose between the more common Cole-Cole (Pelton), Dias, or Debye decomposition models. Simple circuits composed of resistances and constant phase elements may also be used to represent SIP data. Initial guesses are required when using more classic inversion techniques such as the least-squares formulation, and wrong estimates are often the cause of bad curve fitting. In stochastic optimization using MCMC, the effect of the starting values disappears as the simulation proceeds. Our program is then optimized to do batch inversion over large data sets with as little user-interaction as possible. Additionally, the Bayesian formulation allows the user to do quality control by fully propagating the measurement errors in the inversion process, providing an estimation of the SIP parameters uncertainty. This information is valuable when trying to relate chargeability or relaxation time to other physical properties. We test the inversion program on complex resistivity measurements of 12 core samples from the world-class gold deposit of Canadian Malartic. Results show
Gottfriedsen, Tinne B; Schrøder, Henrik M; Odgaard, Anders
BACKGROUND: Transfemoral amputation is considered the last treatment option for failed knee arthroplasty. The extent to which this procedure is performed is not well known. The purpose of this study was to identify the incidence and causes of amputation following failure of knee arthroplasty...... in a nationwide population. METHODS: Data were extracted from the Danish Civil Registration System, the Danish National Patient Register, and the Danish Knee Arthroplasty Register. With use of individual data linkage, 92,785 primary knee arthroplasties performed from 1997 to 2013 were identified. Of these, 258...... for causes related to failed knee arthroplasty. The 15-year cumulative incidence of amputation was 0.32% (95% confidence interval [CI], 0.23% to 0.48%). The annual incidence of amputation following arthroplasties performed from 1997 to 2002 was 0.025% compared with 0.018% following arthroplasties performed...
Ironside, A.M. (Ontario Hydro, Toronto, Ontario (Canada)); Smith, R.M.
The paper summarizes safeguards activities and programs undertaken in Canada. In 1970, Canada, in collaboration with the IAEA, began a study of procedures and equipment required for the application of safeguards to on-line-fueled reactors. In 1977, this assistance was substantially increased and formalized into the Canadian Safeguards Support Program (CSSP). To date, Canada has spent in excess of $35 million Canadian on this program. The CSSP provides support to the IAEA safeguards effort for areas in which Canada has expertise and has been primarily engaged in developing safeguards procedures and equipment for the CANDU power reactors in Canada and throughout the world. Work, projects, and equipment development undertaken by CANDU CSSP are highlighted.
Wright, E.D. [comp.
This report is the eleventh in a series of semi-annual status reports on the research and development program for the safe management and disposal of Canada's nuclear fuel waste. it describes progress achieved in the three major subprograms, engineered systems, natural systems and performance assessment, from 1991 April 1 to September 30. It also gives a brief description of the activities being carried out in preparation for the public and governmental review of the disposal concept. Since 1987, this program has been jointly funded by AECL and Ontario Hydro under the auspices of the CANDU Owners Group (COG).
... Globe and Mail said, an enterprising publication. Despite the existence of the Winston dictionary, some Canadians were still, at the end of the 1950s, prepared to dismiss Canadian lexicography as pointless. When the idea of a Canadian dictionary was introduced to the Dean of Arts and Science at Dalhousie University in ...
Hansen, Torben Bæk; Gromov, Kirill; Kristensen, Billy B; Husted, Henrik; Kehlet, Henrik
Fast-track surgery implies a coordinated perioperative approach aimed at reducing surgical stress and facilitating post-operative recovery. The fast-track programme has reduced post-operative length of stay and has led to shorter convalescence with more rapid functional recovery and decreased morbidity and mortality in total hip arthroplasty. It should now be a standard total hip arthroplasty patient pathway, but fine tuning of the multiple factors in the fast-track pathway is still needed in patients with special needs or high comorbidity burden.
Kutcher, Stanley Paul; Lauria-Horner, Bianca Aurora; MacLaren, Connie Marian; Bujas-Bobanovic, Maja
Background: Depression is frequently unrecognized and undertreated. Therefore, there is a need to increase the knowledge and skills of primary care physicians regarding the diagnosis and treatment of depression. The aim of this study was to provide, and evaluate the impact of, a brief educational program with a number of practice tools and resources in order to improve family physicians' knowledge, diagnosis, and treatment of depression.
Rivard, Léonard P.; Gueye, Ndeye R.
Literacy in the Science Classroom Project was a three-year professional development (PD) program supporting minority-language secondary teachers' use of effective language-based instructional strategies for teaching science. Our primary objective was to determine how teacher beliefs and practices changed over time and how these were enacted in different classrooms. We also wanted to identify the challenges and enablers to implementing these literacy strategies and practices at the classroom, school, and district levels. Data collection involved both qualitative and quantitative methodologies: student questionnaires; interviews with teachers, principals, and mentor; and focus groups with students. The findings suggest that the program had an impact on beliefs and practices commensurate with the workshop participation of individual teachers. These language-enhanced teacher practices also had a positive impact on the use of talking, reading and writing by students in the science classroom. Finally, continuing PD support may be needed in certain jurisdictions for strengthening minority-language programs given the high teacher mobility in content-area classrooms evident in this study.
Levine, W N; Ozuna, R M; Scott, R D; Thornhill, T S
Between January 1983 and January 1991, 29 patients (31 knees) with a failed Robert Brigham metal-backed knee arthroplasty (Johnson & Johnson, Raynham, MA) underwent revision to a total knee arthroplasty (TKA). Twenty-five patients had osteoarthritis, three avascular necrosis, and one rheumatoid arthritis. The average patient age was 72.3 years (range, 49-88 years), and the average weight was 179 lb. (range, 112-242 lb.). The interval between the primary and secondary index procedures averaged 62 months (range, 7-106 months), and mean postrevision follow-up period was 45 months (range, 24-104 months). The primary mechanism of failure of the UKA was tibial polyethylene wear in 21 knees and opposite compartment progression of arthritis in 10 knees. Sixteen knees had particulate synovitis with dense metallic staining of the synovium. At revision, the posterior cruciate ligament was spared in 30 knees and substituted in 1 knee. Restoration of bony deficiency at revision required cancellous bone-graft for contained defects in seven knees, tibial wedges in four knees, and femoral wedges in two knees. No defects received structural allografts. The data suggest that failed, modern unicompartmental knee arthroplasty can successfully be converted to TKA. In most cases, the posterior cruciate ligament can be spared and bone defects corrected with simple wedges or cancellous grafts. Moreover, the results of revision of failed unicompartmental knee arthroplasty are superior to those of failed TKA and failed high tibial osteotomy and comparable to the authors' results of primary TKA with similar-length follow-up periods. Although these results are encouraging, longer-term follow-up evaluation is required to determine survivorship of these revision arthroplasties.
Keyes, Mira; Crook, Juanita; Morris, W. James; Morton, Gerard; Pickles, Tom; Usmani, Nawaid; Vigneault, Eric
Prostate brachytherapy can be used as a monotherapy for low- and intermediate-risk patients or in combination with external beam radiation therapy (EBRT) as a form of dose escalation for selected intermediate- and high-risk patients. Prostate brachytherapy with either permanent implants (low dose rate [LDR]) or temporary implants (high dose rate [HDR]) is emerging as the most effective radiation treatment for prostate cancer. Several large Canadian brachytherapy programs were established in the mid- to late-1990s. Prostate brachytherapy is offered in British Columbia, Alberta, Manitoba, Ontario, Quebec and New Brunswick. We anticipate the need for brachytherapy services in Canada will significantly increase in the near future. In this review, we summarize brachytherapy programs across Canada, contemporary eligibility criteria for the procedure, toxicity and prostate-specific antigen recurrence free survival (PRFS), as published from Canadian institutions for both LDR and HDR brachytherapy. PMID:23671495
P.T.P.W. Burgers (Paul)
markdownabstractThe aim of this thesis is threefold. The first aim is to study the cumulative incidence of bilateral femoral neck fractures and the use of two types of arthroplasty for these fractures. The second aim is to investigate the reliability and validity of the Western Ontario and
Malcherczyk, Dominik; Abdelmoula, Asma; Heyse, Thomas J; Peterlein, Christian D; Greene, Brandon; El-Zayat, Bilal F
The aim of this investigation was to analyse "total blood loss" (TBL), "blood transfusion rate" (BT) and the "amount of transfused blood units" (BU) between the different primary shoulder arthroplasty (SA) types: reverse, anatomical and stemless. Only primary SA was included. Further goal was to identify risk factors for TBL, amount of BU and BT rate. A retrospective charts analysis of patients who received primary SA for degenerative shoulder pathology in our institution between 2004 and 2016 was performed. The demographic data, co-morbidities, haemoglobin and hematocrit level, BT rate, amount of transfused BU etc. were collected. TBL was estimated. Linear regression, log-linear poisson regression and logistic regression were used to compare the outcomes TBL, amount of transfused BU and BT rate, respectively, between different prosthesis types. Of 278 patients included in this study 209 received reverse, 57 anatomical and 12 stemless SA. Mean TBL was 392.7 ml in reverse, 394.6 ml in anatomical and 298.3 ml in stemless SA. The BT rate and mean amount of BU were, respectively, 14.4% and 0.32 in reverse and 8.77% and 0.23 in anatomical SA. None of the patients with stemless arthroplasty received BT. Significant risk factors for elevated TBL are operation time, higher BMI, male sex. Significant risk parameters for BT and higher amount of transfused BU are low BMI, cemented arthroplasty, coronary heart disease, ASA score > 2 and previous therapy with vitamin K antagonists. Although there were little differences between the blood transfusion rates in reverse vs. anatomical arthroplasty, there was no difference in total blood loss between these different prosthesis types. None of the patients with stemless arthroplasty received blood transfusion. There are various risk factors affecting total blood loss and blood transfusion rate. However, risk parameters influencing blood transfusion may be different to them affecting total blood loss.
Canovas, F; Dagneaux, L
Total knee arthroplasty (TKA) results in a high degree of patient satisfaction, as it provides patients with considerable medium- and long-term benefits in terms of quality of life, pain relief and function. Nevertheless, the literature reports that up to 30% of patients are dissatisfied. This dissatisfaction is directly related to the patients' quality of life, which they deem insufficient. Their quality of life depends on many physical, behavioural, social and psychological factors that are not taken into account by functional outcome scores. After describing the principles of quality of life evaluation after TKA, we will assess the effects of patient-related factors, the surgical technique and postoperative program through an exhaustive review of the literature. Patient expectations after TKA will then be outlined, particularly return to work and return to sports. Copyright © 2017. Published by Elsevier Masson SAS.
This project will identify promising practices in Canadian universities' student mobility programs, which are designed to advance the institutions' internationalization strategies. Researchers will examine program partnerships between developing- and developed-countries, along with the success factors behind them.
Nazzal, Mahmoud I.; Bashaireh, Khaldoon H.; Alomari, Mahmoud A.; Nazzal, Mohammad S.; Maayah, Mikhled F.; Mesmar, Mohammad
The aim of this study was to examine patient satisfaction with rehabilitation after total knee arthroplasty (TKA). Fifty-six patients, aged 45-77 years, were enrolled in a post-TKA comprehensive therapy program focusing on knee strengthening and functional activities. The program lasted 3 months and was conducted for 1 h, twice a day, 5 days per…
Scott M. Sporer
Full Text Available DESCRIPTION A user friendly reference for decision making in hip arthroplasty designed in a question formed clinical problem scenarios and answers format .The articles composed of the answers, containing current concepts and preferences of experts in primary and revision hip surgery are enhanced by several images, diagrams and references and written in the form of a curbside consultation by Scott M. Sporer, MD. and his collaborators. PURPOSE By this practical reference of hip arthroplasty, Scott M. Sporer, MD. and the contributors have aimed providing the reader practical and clinically relevant information, evidence-based advices, their preferences and opinions containing current concepts for difficult and controversial clinical situations in total hip replacement surgery which are often not addressed clearly in traditional references. FEATURES The book is composed of 9 sections and 49 articles each written by a different expert designed in a question and answers format including several images and diagrams and also essential references at the end of each article. In the first section preoperative questions is subjected. Second section is about preoperative acetabulum questions. Third section is about preoperative femur questions. Fourth section is about intraoperative questions. Intraoperative acetabulum question is subjected in the fifth section and the intraoperative femur questions in the sixth section. The seventh section is about postoperative questions. Eighth and ninth sections are about general questions about failure and failure of acetabulum in turn. AUDIENCE Mainly practicing orthopedic surgeons, fellows and residents who are interested in hip arthroplasty have been targeted but several carefully designed scenarios of controversial and difficult situations surrounding total hip replacement surgery and the current information will also be welcomed by experienced clinicians practicing in hip arthroplasty. ASSESSMENT Scott M. Sporer
Jenny, Jean-Yves; Louis, Pascal; Diesinger, Yann
The tested hypothesis was following: the High Activity Arthroplasty Score has a significant lower ceiling effect than American Knee Society Score and Oxford Knee Score after total knee arthroplasty. One hundred patients operated on for total knee arthroplasty with more than one-year follow-up have been included. The ceiling effect was 53% for the American Knee Society Score, 33% for the Oxford Knee Score, and 0% for the High Activity Arthroplasty Score. High Activity Arthroplasty Score had a significantly lower ceiling effect than American Knee Society Score and Oxford Knee Score. High Activity Arthroplasty Score has the potential to detect more subtle differences in level of function than standard scoring systems among a non-selected total knee arthroplasty population. © 2014.
Saywell, John; Anastakis, Dimitry; Bryden, Penny E
... the pervasive effects that federalism has on Canadian politics, economics, culture, and history, and provide a detailed framework in which to understand contemporary federalism. Written in honour of John T. Saywell's half-century of accomplished and influential scholarly work and teaching, Framing Canadian Federalism is a timely and fitting t...
Lindberg-Larsen, Martin; Joergensen, Christoffer Calov; Husted, Henrik
Bilateral total hip arthroplasty (BTHA) and bilateral simultaneous total hip arthroplasty (BSTHA) are done increasingly. Previous studies evaluating outcomes after bilateral procedures have found different results. The aim of this study was to investigate length of hospital stay (LOS), 30 days re...
Verspoor, F.G.; Hannink, G.; Scholte, A.; Geest, I.C. van der; Schreuder, H.W.
Background and purpose - Tenosynovial giant cell tumors (t-GCTs) can behave aggressively locally and affect joint function and quality of life. The role of arthroplasty in the treatment of t-GCT is uncertain. We report the results of arthroplasty in t-GCT patients. Patients and methods - t-GCT
Full Text Available Colorectal cancer is the third most prevalent cancer affecting both men and women in Canada. Many of these cancers are preventable, and the Canadian Association of Gastroenterology (CAG and the Canadian Digestive Health Foundation (CDHF strongly support the establishment of screening programs for colorectal cancer. These guidelines discuss a number of screening options, listing the advantages and disadvantages of each. Ultimately, the test that is used for screening should be determined by patient preference, current evidence and local resources.
Gottfriedsen, Tinne B; Morville Schrøder, Henrik; Odgaard, Anders
BACKGROUND: Arthrodesis is considered a salvage procedure after failure of a knee arthroplasty. Data on the use of this procedure are limited. The purpose of this study was to identify the incidence, causes, surgical techniques, and outcomes of arthrodesis after failed knee arthroplasty...... in a nationwide population. METHODS: Data were extracted from the Danish Civil Registration System, the Danish National Patient Register, and the Danish Knee Arthroplasty Register. A total of 92,785 primary knee arthroplasties performed in Denmark from 1997 to 2013 were identified by linking the data using....... Differences in cumulative incidence were compared with the Gray test. RESULTS: A total of 164 of the 165 arthrodeses were performed for causes related to failed knee arthroplasty. The 15-year cumulative incidence of arthrodesis was 0.26% (95% confidence interval, 0.21% to 0.31%). The 5-year cumulative...
Gottfriedsen, Tinne B; Schrøder, Henrik M; Odgaard, Anders
BACKGROUND: Transfemoral amputation is considered the last treatment option for failed knee arthroplasty. The extent to which this procedure is performed is not well known. The purpose of this study was to identify the incidence and causes of amputation following failure of knee arthroplasty...... were followed by amputation. Hospital records of all identified cases were reviewed. A competing-risk model was used to estimate the cumulative incidence of amputation. Differences in cumulative incidences were analyzed with use of the Gray test. RESULTS: A total of 115 amputations were performed...... for causes related to failed knee arthroplasty. The 15-year cumulative incidence of amputation was 0.32% (95% confidence interval [CI], 0.23% to 0.48%). The annual incidence of amputation following arthroplasties performed from 1997 to 2002 was 0.025% compared with 0.018% following arthroplasties performed...
Full Text Available It is standard practice in many institutions to routinely perform preoperative and postoperative haemoglobin level testing in association with hip joint arthroplasty procedures. It is our observation, however, that blood transfusion after uncomplicated primary hip arthroplasty in healthy patients is uncommon and that the decision to proceed with blood transfusion is typically made on clinical grounds. We therefore question the necessity and clinical value of routine perioperative blood testing about the time of hip resurfacing arthroplasty. We present analysis of perioperative blood tests and transfusion rates in 107 patients undertaking unilateral hybrid hip resurfacing arthroplasty by the senior author at a single institution over a three-year period. We conclude that routine perioperative testing of haemoglobin levels for hip resurfacing arthroplasty procedures does not assist in clinical management. We recommend that postoperative blood testing only be considered should the patient demonstrate clinical signs of symptomatic anaemia or if particular clinical circumstances necessitate.
Becker, W J; Christie, S N; Mackie, G; Cooper, P
Migraine is a significant cause of suffering and disability in the Canadian population, and imposes a major cost on Canadian Society. Based on current medical science, much more could be done to provide better comprehensive medical care to the millions of individuals with migraine in Canada. To propose and design a national Canadian Migraine Strategy which could be implemented to reduce migraine related disability in Canada. A multidisciplinary task force of the Canadian Headache Society met for a Canadian Migraine Summit Meeting in Halifax, Nova Scotia in June, 2009. Pertinent literature was reviewed and a consensus document was produced based upon the round table discussion at the meeting. The outline of a national Canadian Migraine Strategy was created. This strategy is based on the chronic disease management model, and would include: an outline of what constitutes appropriate migraine care for Canadians, educational programs (for health care professionals, individuals with migraine, and the general public), research programs, and the development of the necessary organizations and partnerships to develop further and implement the Canadian Migraine Strategy. Based upon the medical literature and expert discussion at the meeting, a national Canadian Migraine Strategy with a patient self-management focus has the potential to improve patient care and reduce headache related disability in Canada.
Sanders, Thomas L; Maradit Kremers, Hilal; Schleck, Cathy D; Larson, Dirk R; Berry, Daniel J
Despite the large increase in total hip arthroplasties and total knee arthroplasties, the incidence and prevalence of additional contralateral or ipsilateral joint arthroplasty are poorly understood. The purpose of this study was to determine the rate of additional joint arthroplasty after a primary total hip arthroplasty or total knee arthroplasty. This historical cohort study identified population-based cohorts of patients who underwent primary total hip arthroplasty (n = 1,933) or total knee arthroplasty (n = 2,139) between 1969 and 2008. Patients underwent passive follow-up through their medical records beginning with the primary total hip arthroplasty or total knee arthroplasty. We assessed the likelihood of undergoing a subsequent total joint arthroplasty, including simultaneous and staged bilateral procedures. Age, sex, and calendar year were evaluated as potential predictors of subsequent arthroplasty. During a mean follow-up of 12 years after an initial total hip arthroplasty, we observed 422 contralateral total hip arthroplasties (29% at 20 years), 76 contralateral total knee arthroplasties (6% at 10 years), and 32 ipsilateral total knee arthroplasties (2% at 20 years). Younger age was a significant predictor of contralateral total hip arthroplasty (p hip arthroplasties (3% at 20 years), and 29 ipsilateral total hip arthroplasties (2% at 20 years). Older age was a significant predictor of ipsilateral or contralateral total hip arthroplasty (p hip arthroplasty or total knee arthroplasty can be informed of a 30% to 45% chance of a surgical procedure in a contralateral cognate joint and about a 5% chance of a surgical procedure in noncognate joints within 20 years of initial arthroplasty. Increased risk of contralateral total knee arthroplasty following an initial total hip arthroplasty may be due to gait changes prior to and/or following total hip arthroplasty. The higher prevalence of bilateral total hip arthroplasty in younger patients may result from
Judd, Dana L; Winters, Joshua D; Stevens-Lapsley, Jennifer E; Christiansen, Cory L
Following total hip arthroplasty, patients demonstrate compensatory movement strategies during activities of daily living such as walking and stair climbing. Movement compensations are important markers of functional decline in older adults and are related to poor functional capacity. Despite increased utilization of hip arthroplasty, persistent movement compensation, and functional performance deficits, no consensus on postoperative rehabilitation exists. Neuromuscular reeducation techniques offer a strategy to improve movement quality by emphasizing hip abductor performance and pelvic stability. This case series illustrates changes in movement strategy around the hip in response to targeted neuromuscular reeducation techniques after hip arthroplasty. Five participants received an 8-week exercise program following total hip arthroplasty, emphasizing targeted neuromuscular reeducation techniques hallmarked by specific, weight-bearing exercise to improve hip abductor performance and pelvic stability. Five additional participants were supervised and followed for comparison. Participants in the neuromuscular reeducation program improved their internal hip abductor moments and vertical ground reaction forces during walking and stair climbing. They also improved their functional performance and hip abductor strength outcomes. Targeted neuromuscular reeducation techniques after total hip arthroplasty provided a positive effect on biomechanical outcomes, functional performance, and muscle strength. Through focused use of the hip abductor muscles, increased internal hip abductor moments were observed. This intervention potentially promotes pelvic stability, and may contribute to improved performance on tasks such as stair climbing, fast walking, and balance. The results suggest that neuromuscular reeducation offers a unique effect on movement strategy and function for patients following total hip arthroplasty. Copyright © 2016 Elsevier Ltd. All rights reserved.
Florez-García, Mariano; García-Pérez, Fernando; Curbelo, Rafael; Pérez-Porta, Irene; Nishishinya, Betina; Rosario Lozano, Maria Piedad; Carmona, Loreto
The aim of the present study was to evaluate the efficacy and safety of non-supervised home-based exercise versus individualized and supervised programs delivered in clinic-based settings for the functional recovery immediately after discharge from a primary TKA. Medline, Embase, Cochrane, and PEDro databases were screened, from inception to April 2015, in search for randomized clinical trials (RCT) of home-based exercise interventions versus individualized and supervised outpatient physical therapy after primary TKA. Target outcomes were: knee range of motion (ROM), patient-reported pain and function, functional performance, and safety. Risk of bias was assessed with the PEDro scale. After assessing homogeneity, data were combined using random effects meta-analysis and reported as standardized mean differences or mean differences. We set a non-inferiority margin of four points in mean differences. The search and selection process identified 11 RCT of moderate quality and small sample sizes. ROM active extension data suitable for meta-analysis was available from seven studies with 707 patients, and ROM active flexion from nine studies with 983 patients. Most studies showed no difference between groups. Pooled differences were within the non-inferiority margin. Most meta-analyses showed significant statistical heterogeneity. Short-term improvements in physical function and knee ROM do not clearly differ between outpatient physiotherapy and home-based exercise regimes in patients after primary TKA; however, this conclusion is based on a meta-analysis with high heterogeneity. I.
Gundtoft, Per Hviid; Varnum, Claus; Pedersen, Alma Becic; Overgaard, Søren
The aim of the Danish Hip Arthroplasty Register (DHR) is to continuously monitor and improve the quality of treatment of primary and revision total hip arthroplasty (THA) in Denmark. The DHR is a Danish nationwide arthroplasty register established in January 1995. All Danish orthopedic departments - both public and private - report to the register, and registration is compulsory. The main variables in the register include civil registration number, indication for primary and revision surgery, operation date and side, and postoperative complications. Completeness of primary and revision surgery is evaluated annually and validation of a number of variables has been carried out. A total of 139,525 primary THAs and 22,118 revisions have been registered in the DHR between January 1, 1995 and December 31, 2014. Since 1995, completeness of procedure registration has been high, being 97.8% and 92.0% in 2014 for primary THAs and revisions, respectively. Several risk factors, such as comorbidity, age, specific primary diagnosis and fixation types for failure of primary THAs, and postoperative complications, have been identified through the DHR. Approximately 9,000 primary THAs and 1,500 revisions are reported to the register annually. The DHR is important for monitoring and improvement of treatment with THA and is a valuable tool for research in THA surgery due to the high quality of prospective collected data with long-term follow-up and high completeness. The register can be used for population-based epidemiology studies of THA surgery and can be linked to a range of other national databases.
Bandholm, Thomas; Kehlet, Henrik
Bandholm T, Kehlet H. Physiotherapy exercise after fast-track total hip and knee arthroplasty: time for reconsideration? Major surgery, including total hip arthroplasty (THA) and total knee arthroplasty (TKA), is followed by a convalescence period, during which the loss of muscle strength......-track methodology or enhanced recovery programs. It is the nature of this methodology to systematically and scientifically optimize all perioperative care components, with the overall goal of enhancing recovery. This is also the case for the care component "physiotherapy exercise" after THA and TKA. The 2 latest...... meta-analyses on the effectiveness of physiotherapy exercise after THA and TKA generally conclude that physiotherapy exercise after THA and TKA either does not work or is not very effective. The reason for this may be that the "pill" of physiotherapy exercise typically offered after THA and TKA does...
This report is an overview of Canadians' eating habits: total calories consumed and the number of servings from the various food groups, as well as the percentage of total calories from fat, protein and carbohydrates...
Power, F R; Cawley, D T; Curtin, P D
Total hip arthroplasty (THA) is an effective and durable treatment option for hip osteoarthritis (OA). As life expectancy continues to increase, so too will the demand for joint arthroplasty in the 10th decade of life, frequently in cases involving osteoarthritis of both hips. Simultaneous bilateral total hip arthroplasty (SBTHA) is a valuable therapeutic option in appropriately selected patients with bilateral degenerative hip disease, although its use in the very elderly is poorly reported on in the literature. A case of bilateral hip OA successfully treated with SBTHA in a nonagenarian is presented and the literature is reviewed.
Kim, Da Rae; Choi, Yun Sun; Chun, Ka Young; Jung, Yoon Young; Kim, Jin Su; Young, Ki Won [Eulji Hospital, Eulji University, Seoul (Korea, Republic of); Potter, Hollis G.; Li, Angela E. [Dept. of Radiology and Imaging, Hospital for Special Surgery, New York (United States)
With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice.
Gottfriedsen, Tinne B; Morville Schrøder, Henrik; Odgaard, Anders
BACKGROUND: Arthrodesis is considered a salvage procedure after failure of a knee arthroplasty. Data on the use of this procedure are limited. The purpose of this study was to identify the incidence, causes, surgical techniques, and outcomes of arthrodesis after failed knee arthroplasty...... of 34 patients (21%) underwent repeat arthrodesis, and 23 patients (14%) eventually underwent transfemoral amputation. CONCLUSIONS: The cumulative incidence of arthrodesis within 15 years after primary knee arthroplasty was 0.26%. There was a significant decrease in the 5-year cumulative incidence...
Kester, Benjamin S; Merkow, Ryan P; Ju, Mila H; Peabody, Terrance D; Bentrem, David J; Ko, Clifford Y; Bilimoria, Karl Y
Symptomatic pre-discharge venous thromboembolism (VTE) rates after total or partial hip or knee arthroplasty have been proposed as patient safety indicators. However, assessing only pre-discharge VTE rates may be suboptimal for quality measurement as the duration of stay is relatively short and the VTE risk extends beyond the inpatient setting. Patients who underwent total or partial hip or knee arthroplasty were identified in the 2008 through 2010 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Outcomes of interest were the deep venous thrombosis (DVT), pulmonary embolism (PE), and overall VTE rates within thirty days after surgery and the rates during the pre-discharge and post-discharge portions of this time period. Risk-adjusted hospital rankings based on only pre-discharge (inpatient) events were compared with those based on both pre-discharge and post-discharge events within thirty days of surgery. A total of 23,924 patients underwent total or partial hip arthroplasty (8499) or knee arthroplasty (15,425) at ninety-five hospitals. For hip arthroplasty, the VTE rate was 0.9%, with 57.9% of the events occurring after discharge. For knee arthroplasty, the VTE rate was 1.9%, with 38.3% of the events occurring after discharge. The median time of VTE occurrence was eleven days postoperatively for hip arthroplasty and three days for knee arthroplasty. The median duration of stay was three days for both hip and knee arthroplasty. When hospitals were ranked according to VTE rates, hospital outlier status designations changed when post-discharge events were included (κ = 0.386; 44% false-positive rate for low outliers). The median change in hospital quality ranking was 7 (interquartile range, 2 to 17), with a rank correlation of r = 0.82. Nearly twice as many VTE complications were captured if both pre-discharge and post-discharge events were considered, and inclusion of post-discharge events changed hospital quality
Stall, Nathan M; Kagoma, Yoan M; Bondy, Jennifer N; Naudie, Douglas
Operating rooms (ORs) are estimated to generate up to one-third of hospital waste. At the London Health Sciences Centre, prosthetics and implants represent 17% of the institution's ecological footprint. To investigate waste production associated with total knee arthroplasties (TKAs), we performed a surgical waste audit to gauge the environmental impact of this procedure and generate strategies to improve waste management. We conducted a waste audit of 5 primary TKAs performed by a single surgeon in February 2010. Waste was categorized into 6 streams: regular solid waste, recyclable plastics, biohazard waste, laundered linens, sharps and blue sterile wrap. Volume and weight of each stream was quantified. We used Canadian Joint Replacement Registry data (2008-2009) to estimate annual weight and volume totals of waste from all TKAs performed in Canada. The average surgical waste (excluding laundered linens) per TKA was 13.3 kg, of which 8.6 kg (64.5%) was normal solid waste, 2.5 kg (19.2%) was biohazard waste, 1.6 kg (12.1%) was blue sterile wrap, 0.3 kg (2.2%) was recyclables and 0.3 kg (2.2%) was sharps. Plastic wrappers, disposable surgical linens and personal protective equipment contributed considerably to total waste. We estimated that landfill waste from all 47 429 TKAs performed in Canada in 2008-2009 was 407 889 kg by weight and 15 272 m3 by volume. Total knee arthroplasties produce substantial amounts of surgical waste. Environmentally friendly surgical products and waste management strategies may allow ORs to reduce the negative impacts of waste production without compromising patient care. Level IV, case series.
Stucinskas, Justinas; Robertsson, Otto; Wingstrand, Hans
Background and purpose We have previously reported that the first 10 years of hip arthroplasty in Lithuania resulted in a higher cumulative revision rate than that observed in Sweden. We thus compared the corresponding results after introduaction of total knee replacement in Lithuania. Methods The 10-year revision rate for the first 595 primary ScanKnee arthroplasties inserted in Klaipeda, Lithuania, was compared to that for the first 1,280 ScanKnee primary arthroplasties inserted in Sweden. As in the hip replacement study, only patients with osteoarthritis (OA) were included. Primary knee arthroplasties without patellar resurfacing were included, and the endpoint was revision for any reason other than addition of a patellar component. Results We found that the cumulative revision rate was not statistically significantly different between the groups. The revision pattern was different, however, and we observed 24 isolated patellar component additions in Sweden, but none in Klaipeda. Interpretation Contrary to the results of our previous hip arthroplasty study, the cumulative revision rate after total knee arthroplasty was similar in the two groups. This suggests that compared to hip arthroplasty, the outcome of total knee arthroplasty was less dependent on surgical experience. The large difference regarding isolated patellar component additions may be explained by long-term accumulation of severe OA cases in Lithuania. To patients subject to a newly introduced surgical treatment offering great improvement in quality of life, patellofemoral pain may be a minor problem. Furthermore, patellar problems may not have seemed particularly relevant for the surgeons, considering the disability of other patients waiting to be treated. PMID:19297790
Jacofsky, David J; Allen, Mark
Robotic-assisted orthopedic surgery has been available clinically in some form for over 2 decades, claiming to improve total joint arthroplasty by enhancing the surgeon's ability to reproduce alignment and therefore better restore normal kinematics. Various current systems include a robotic arm, robotic-guided cutting jigs, and robotic milling systems with a diversity of different navigation strategies using active, semiactive, or passive control systems. Semiactive systems have become dominant, providing a haptic window through which the surgeon is able to consistently prepare an arthroplasty based on preoperative planning. A review of previous designs and clinical studies demonstrate that these robotic systems decrease variability and increase precision, primarily focusing on component positioning and alignment. Some early clinical results indicate decreased revision rates and improved patient satisfaction with robotic-assisted arthroplasty. The future design objectives include precise planning and even further improved consistent intraoperative execution. Despite this cautious optimism, many still wonder whether robotics will ultimately increase cost and operative time without objectively improving outcomes. Over the long term, every industry that has seen robotic technology be introduced, ultimately has shown an increase in production capacity, improved accuracy and precision, and lower cost. A new generation of robotic systems is now being introduced into the arthroplasty arena, and early results with unicompartmental knee arthroplasty and total hip arthroplasty have demonstrated improved accuracy of placement, improved satisfaction, and reduced complications. Further studies are needed to confirm the cost effectiveness of these technologies. Copyright © 2016 Elsevier Inc. All rights reserved.
Johnson, Christine C; Johnson, Daniel J; Liu, Joseph N; Dines, Joshua S; Dines, David M; Gulotta, Lawrence V; Garcia, Grant H
Many patients prioritize the ability to return to sports following shoulder replacement surgeries, including total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA), and hemiarthroplasty (HA). While activity levels after hip and knee replacements have been well-established in the literature, studies on this topic in the field of shoulder arthroplasty are relatively limited. A review of the literature regarding athletic activity after shoulder arthroplasty was performed using the PubMed database. All studies relevant to shoulder arthroplasty and return to sport were included. The majority of patients returned to their prior level of activity within six months following TSA, RTSA, and shoulder HA. Noncontact, low demand activities are permitted by most surgeons postoperatively and generally have higher return rates than contact sports or high-demand activities. In some series, patients reported an improvement in their ability to participate in sports following the arthroplasty procedure. The rates of return to sports following TSA (75%-100%) are slightly higher than those reported for HA (67%-76%) and RTSA (75%-85%). Patients undergoing TSA, RTSA, and shoulder HA should be counseled that there is a high probability that they will be able to return to their preoperative activity level within six months postoperatively. TSA has been associated with higher rates of return to sports than RTSA and HA, although this may reflect differences in patient population or surgical indication. PMID:27672564
Apitz, Sabine E; Agius, Suzanne
The effects of possible changes to the Canadian 2-tiered assessment framework for dredged material based on outcomes of the 2006 Contaminated Dredged Material Management Decisions Workshop (CDMMD) are evaluated. Expanding on the "data mining" approach described in a previous paper, which focused solely on chemical lines of evidence, the efficacy of Tier 1 approaches (increases to the number of chemical analytes, use of mean hazard quotients, and the use of a screening bioassay) in predicting toxicity are evaluated. Results suggest value in additional work to evaluate the following areas: 1) further expanding minimum chemical requirements, 2) using more advanced approaches for chemical interpretation, and 3) using a screening-level bioassay (e.g., Canadian solid-phase photoluminescent bacteria test) to determine whether it would complement Tier 1 chemistry as well as or better than the solvent-based Microtox™ test method evaluated in the present study. Integr Environ Assess Manag 2017;13:1072-1085. © 2017 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC). © 2017 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).
Heyse, Thomas J.; El-Zayat, Bilal F.; De Corte, Ronny; Scheys, Lennart; Chevalier, Yan; Fuchs-Winkelmann, Susanne; Labey, Luc
Modular bicompartmental knee arthroplasty (BKA) for treatment of medio-patellofemoral osteoarthritis (OA) should allow for close to normal kinematics in comparison with unicondylar knee arthroplasty (UKA) and the native knee. There is so far no data to support this.
Husted, Henrik; Jørgensen, Christoffer C.; Gromov, Kirill
Background and purpose - Body mass index (BMI) outside the normal range possibly affects the perioperative morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in traditional care programs. We determined perioperative morbidity and mortality in such pat......Background and purpose - Body mass index (BMI) outside the normal range possibly affects the perioperative morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in traditional care programs. We determined perioperative morbidity and mortality...... in such patients who were operated with the fast-track methodology and compared the levels with those in patients with normal BMI. Patients and methods - This was a prospective observational study involving 13,730 procedures (7,194 THA and 6,536 TKA operations) performed in a standardized fast-track setting....... Complete 90-day follow-up was achieved using national registries and review of medical records. Patients were grouped according to BMI as being underweight, of normal weight, overweight, obese, very obese, and morbidly obese. Results - Median length of stay (LOS) was 2 (IQR: 2-3) days in all BMI groups. 30...
Jans, Øivind; Kehlet, H; Hussain, Zubair Butt
Background and Objectives The optimal transfusion strategy in hip arthroplasty remains controversial despite existing guidelines. The aim of this study was to evaluate the transfusion practice in patients undergoing primary total hip arthroplasty (THA) or revision total hip arthroplasty (RTHA) in...
Basques, Bryce A; Tetreault, Matthew W; Della Valle, Craig J
Discharge from the hospital on the day of (same-day) hip and knee arthroplasties has become more common; however, to our knowledge, few studies have compared morbidity between same-day and inpatient surgical procedures. The aims of this study were to compare matched cohorts of patients who underwent same-day and inpatient hip or knee arthroplasty in terms of postoperative complications and 30-day readmission rates. Patients who underwent primary elective total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty from 2005 to 2014 were identified from the National Surgical Quality Improvement Program registry. Patients discharged the day of the surgical procedure were matched 1:1 with patients who had an inpatient stay using propensity scores. The rates of 30-day adverse events and readmission were compared between matched cohorts using the McNemar test. Risk factors for 30-day readmission following same-day procedures were identified using multivariate regression. Of 177,818 patients identified, 1,236 (0.70%) underwent a same-day surgical procedure. After matching, there were no differences in overall adverse events or readmission between same-day and inpatient groups, although inpatients had increased thromboembolic events (p = 0.048) and same-day patients had an increased rate of return to the operating room (p = 0.016). When procedures were assessed individually, the only difference identified was that the same-day total knee arthroplasty cohort had an increased return to the operating room compared with the inpatient total knee arthroplasty cohort (p = 0.046). Body mass index of ≥35 kg/m (p = 0.035), insulin-dependent diabetes (p = 0.041), non-insulin-dependent diabetes (p = 0.013), and age of ≥85 years (p = 0.039) were associated with 30-day readmission following same-day surgical procedures. Infection was the most common reason for reoperation and readmission following same-day procedures. No significant differences in overall
Ni, Sheng-Hui; Jiang, Wen-Tong; Guo, Lei; Jin, Yu-Heng; Jiang, Tian-Long; Zhao, Yuyan; Zhao, Jie
The effectiveness of cryotherapy on joint arthroplasty recovery remains controversial. This systematic review was conducted to assess the effectiveness of cryotherapy in patients after joint arthroplasty. Comprehensive literature searches of several databases including Cochrane Library (2013), MEDLINE (1950-2013), and Embase (1980-2013) were performed. We sought randomised controlled trials that compared the experimental group received any form of cryotherapy with any control group after joint arthroplasty. The main outcomes were postoperative blood loss, adverse events, and pain. Analyses were performed with Revman 5.0. Results were shown as mean differences (MD) and standard deviations or as risk difference and 95 % confidence intervals (CIs). Ten trials comprised 660 total knee arthroplastys and three trials comprised 122 total hip arthroplastys (THAs) met the inclusion criteria. Blood loss was significantly decreased by cryotherapy (MD = -109.68; 95 % CI -210.92 to -8.44; P = 0.03). Cryotherapy did not increase the risk of adverse effect (n.s.). Cryotherapy decreased pain at the second day of postoperative (MD = -1.32; 95 % CI -2.37 to -0.27; P = 0.0003), but did not decreased pain at the first and third day of postoperative (n.s.). Cryotherapy appears effective in these selected patients after joint arthroplasty. The benefits of cryotherapy on blood loss after joint arthroplasty were obvious. However, the subgroup analysis indicated that cryotherapy did not decreased blood loss after THA. Cryotherapy did not increase the risk of adverse effect. Cryotherapy decreased pain at the second day of postoperative, but did not decreased pain at the first and third day of postoperative. II.
Zijlstra, Wierd P; van den Akker-Scheek, Inge; Zee, Mark J M; van Raay, Jos J A M
PURPOSE: We aimed to test the claim of greater range of motion (ROM) with large femoral head metal-on-metal total hip arthroplasty. METHODS: We compared 28-mm metal-on-polyethylene (MP) total hip arthroplasty with large femoral head metal-on-metal (MM) total hip arthroplasty in a randomised clinical
An emerging group of leaders in Canadian education has attracted thousands of followers. They've made Twitter an extension of their lives, delivering twenty or more tweets a day that can include, for example, links to media articles, research, new ideas from education bloggers, or to their own, or simply a personal thought. At their best,…
Wiater, Brett P; Moravek, James E; Wiater, J Michael
As the incidence of shoulder arthroplasty continues to rise, the orthopedic shoulder surgeon will be increasingly faced with the difficult problem of evaluating a failed shoulder arthroplasty. The patient is usually dissatisfied with the outcome of the previous arthroplasty as a result of pain, but may complain of poor function due to limited range of motion or instability. A thorough and systematic approach is necessary so that the most appropriate treatment pathway can be initiated. A comprehensive history and physical examination are the first steps in the evaluation. Diagnostic studies are numerous and include laboratory values, plain radiography, computed tomography, ultrasound imaging, joint aspiration, nuclear scans, and electromyography. Common causes of early pain after shoulder arthroplasty include technical issues related to the surgery, such as malposition or improper sizing of the prosthesis, periprosthetic infection, neurologic injury, and complex regional pain syndrome. Pain presenting after a symptom-free interval may be related to chronic periprosthetic infection, component wear and loosening, glenoid erosion, rotator cuff degeneration, and fracture. Poor range of motion may result from inadequate postoperative rehabilitation, implant-related factors, and heterotopic ossification. Instability is generally caused by rotator cuff deficiency and implant-related factors. Unfortunately, determining the cause of a failed shoulder arthroplasty can be difficult, and in many situations, the source of pain and disability is multifactorial. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.
Waddell, Bradford S; Carroll, Kaitlin; Jerabek, Seth
Total joint arthroplasty is regarded as a highly successful procedure. Patient outcomes and implant longevity, however, are related to proper alignment and position of the prostehses. In an attempt to reduce outliers and improve accuracy and precision of component position, navigation and robotics have been introduced. These technologies, however, come at a price. The goals of this review are to evaluate these technologies in total joint arthroplasty and determine if they add value. Recent studies have demonstrated that navigation and robotics in total joint arthroplasty can decrease outliers while improving accuracy in component positioning. While some studies have demonstrated improved patient reported outcomes, not all studies have shown this to be true. Most studies cite increased cost of equipment and longer operating room times as the major downsides of the technologies at present. Long-term studies are just becoming available and are promising, as some studies have shown decreased revision rates when navigation is used. Finally, there are relatively few studies evaluating the direct cost and value of these technologies. Navigation and robotics have been shown to improve component position in total joint arthroplasty, which can improve patient outcomes and implant longevity. These technologies offer a promising future for total joint arthroplasty.
Keren, Amit; Berkovich, Yaron; Berkovitch, Yaron; Soudry, Michael
Joint arthroplasty is one of the commonest surgical procedures in orthopedic surgery. In recent years there was an increase in the number of procedures, patient satisfaction and implant survival. Originally, these operations were designed for old patients in order to relieve pain and to enable ambulation. Over the past few years, these operations have become common in younger patients which desire to return to activity, including sports activities. The importance of physical activity is a well known fact. In recent years it became clear that with the proper physical activity the outcomes of the operations are better. There are several types of arthroplasty. Many factors influence the outcome of the operation apart from the post-surgery physical activity. These factors include patient factors, surgical technique and type of arthroplasty. This review summarizes the recommendations for sports activities after hip and knee arthroplasties. These activities are evaluated according to surgeons' recommendations, stress applied on the implant and long term outcomes. The recommended sports activities after joint arthroplasties are walking, swimming and cycling. Soccer, basketball and jogging are not advised. Tennis, downhill skiing and horse riding are recommended with previous experience. There are many more sports activities that patients can participate in, and it is important that the patient discuss the different options prior to the operation. Since these operations are so common, many non-orthopedic physicians encounter these patients in their practice. They should be acquainted with the recommendations for sports activities and encourage them.
Langevin, M.; Huinck, W.J.; Kully, D.; Peters, H.F.M.; Lomheim, H.; Tellers, M.
There is a need to evaluate the effectiveness of stuttering treatment programs delivered in domestic and international contexts and to determine if treatment delivered internationally is culturally sensitive. Evaluation of the effectiveness of the ISTAR Comprehensive Stuttering Program (CSP) within
Edwards, Brian D.; Childs, Jonathan R.; Triezenberg, Peter J.; Danforth, William W.; Gibbons, Helen
In August and September 2010, the U.S. Geological Survey, in cooperation with Natural Resources Canada, Geological Survey of Canada, conducted bathymetric and geophysical surveys in the Beaufort Sea and eastern Arctic Ocean aboard the U.S. Coast Guard Cutter Healy. The principal objective of this mission to the high Arctic was to acquire data in support of a delineation of the outer limits of the U.S. and Canadian Extended Continental Shelf in the Arctic Ocean, in accordance with the provisions of Article 76 of the United Nations Convention on the Law of the Sea. The Healy was accompanied by the Canadian Coast Guard icebreaker Louis S. St-Laurent. The scientific parties on board the two vessels consisted principally of staff from the U.S. Geological Survey (Healy), and the Geological Survey of Canada and the Canadian Hydrographic Service (Louis). The crew also included marine-mammal observers, Native-community observers, ice observers, and biologists conducting research of opportunity in the Arctic Ocean. Despite interruptions necessitated by three medical emergencies, the joint survey proved largely successful. The Healy collected 7,201 trackline-kilometers of swath (multibeam) bathymetry (47,663 square kilometers) and CHIRP subbottom data, with accompanying marine gravity measurements, and expendable bathythermograph data. The Louis acquired 3,673 trackline-kilometers of multichannel seismic (airgun) deep-penetration reflection data along 25 continuous profiles, as well as 34 sonobuoy refraction stations and 9,500 trackline-kilometers of single-beam bathymetry. The coordinated efforts of the two vessels resulted in seismic-reflection-profile data that were of much higher quality and continuity than if the data had been acquired with a single vessel alone. The equipment-failure rate of the seismic equipment aboard the Louis was greatly reduced when the Healy led as the ice breaker. When ice conditions proved too severe to deploy the seismic system, the Louis led
Abe, Hirohito; Sakai, Takashi; Nishii, Takashi; Takao, Masaki; Nakamura, Nobuo; Sugano, Nobuhiko
Jogging has been classified as a high-impact sport, and jogging after total hip arthroplasty (THA) has not been well documented. To investigate the participation rate for postoperative jogging as well as jogging parameters and the influence of jogging on implant stability and bearing wear. Case-control study; Level of evidence, 3. Included in this study were 804 hips in 608 patients (85 men, 523 women) who underwent THA between 2005 and 2011 with follow-up longer than 1 year. The mean patient age was 62 years (range, 26-98 years), and mean follow-up duration was 4.8 years (range, 2.3-7.8 years). Hip resurfacing arthroplasty (HRA) was performed in 81 patients and conventional THA in 527 patients. During routine postsurgical visits, patients were given a questionnaire concerning preoperative and postoperative jogging routines. For joggers, frequency, distance, duration, and velocity of jogging were recorded. Patients who did not jog postoperatively were asked to provide reasons for not jogging. Radiographs concerning implant migration and polyethylene wear were evaluated with specialized software, and serum cobalt and chromium ion concentrations were investigated for patients with metal-on-metal articulation. A total of 33 patients (5.4%) performed jogging preoperatively, and 23 patients (3.8%) performed jogging postoperatively. Of the 23 who jogged postoperatively, conventional THA was performed in 13 patients and HRA in 10 patients. Postoperatively, joggers trained a mean of 4 times (range, 1-7 times) per week, covering a mean distance of 3.6 km (range, 0.5-15 km) in a mean time of 29 minutes (range, 5-90 minutes) per session and at a mean speed of 7.7 km/h (range, 3-18 km/h). No patient complained of pain or showed serum cobalt and chromium ion elevation greater than 7 ppb. No hip showed loosening, abnormal component migration, or excessive wear at a mean 5-year follow-up. There were 74 postoperative non-joggers with an interest in jogging. The reasons given for
Invasive Haemophilus influenzae Type b (Hib) Infections in Children with Cancer in the Era of Infant Hib Immunization Programs (1991-2014): A Report from the Canadian Immunization Monitoring Program Active.
McNair, Joanne; Smith, Alyssa; Bettinger, Julie A; Vaudry, Wendy; Tan, Ben; Desai, Shalini; Halperin, Scott A; Top, Karina A
We studied the epidemiology of Haemophilus influenzae type b (Hib) infections among children with cancer admitted to Canadian pediatric hospitals. From 1991-2014, 13 cases among children with cancer were identified through active surveillance. Average age was 6.7 years. Six of 7 cases eligible for infant immunization were age-appropriately immunized (vaccine failures). Children with cancer may benefit from booster Hib immunization.
Haspl, M; Pećina, M; Orlić, D; Cicak, N
From 1992 to 1995, replacement of the joint with an endoprosthesis after serious wounding and major destruction of joint elements was performed in 10 soldiers. Arthroplasty was performed on five knees, three hips, and two shoulders. The age range of the wounded soldiers was 22 to 55 years (mean, 37.7 years). Six soldiers suffered explosive injuries, and 4 were injured by gunfire. Time elapsed from the moment of wounding to the time of total joint replacement was 9 to 42 months. We decided on arthroplasty as the preferred treatment because of the presence of strong contractures and very painful movement. In 8 patients, the results of the treatment, based on a follow-up time of 36 to 48 months, were good. In 2 patients, early septic arthritis developed after arthroplasty of the knee with concomitant loosening of the endoprosthesis. Staphylococcus aureus was detected in both patients. In those 2 patients, therefore, arthrodesis of the knee with external fixation was performed.
Melloni, Pietro [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)], E-mail: firstname.lastname@example.org; Valls, Rafael; Veintemillas, Maite [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)
The purpose of this study is to describe complications affecting the patella in patients with total or partial knee arthroplasty. We respectively analysed plain-film radiographs, as well as ultrasound images when acquired, in a consecutive series of 1272 patients. The mean interval from knee replacement to patellar complications was 5 years and 7 months (range, 5 months to 14 years). The complications described include fracture, instability, dislocation or luxation, necrosis of the patella, infection of the patella, erosion of the patella, patellar impingement on the prosthesis and patellar or quadricipital tendon tear. We discuss the pathological imaging findings in the patella and their differential diagnosis after knee arthroplasty. Patellar complications after knee arthroplasty are uncommon but often potentially serious.
Fast-track hip and knee arthroplasty aims at giving the patients the best available treatment at all times, being a dynamic entity. Fast-track combines evidence-based, clinical features with organizational optimization including a revision of traditions resulting in a streamlined pathway from...... on clinical and organizational aspects of fast-track hip and knee arthroplasty (I–IX). A detailed description of the fast-track set-up and its components is provided. Major results include identification of patient characteristics to predict length of stay and satisfaction with different aspects...... of the hospital stay (I); how to optimize analgesia by using a compression bandage in total knee arthroplasty (II); the clinical and organizational set-up facilitating or acting as barriers for early discharge (III); safety aspects following fast-track in the form of few readmissions in general (IV) and few...
Full Text Available Arthritis is a disease that acts irreversibly on joint surfaces with significant consequences especially in the third quarter of life. About 7% of our population is affected by arthritis localized at a certain level and stage of development, and this percentage is expected to reach a much higher value in future years. Aim: The aim of this study is to propose a rehabilitation program for functional recovery after total hip arthroplasty and a set of recommendations for post surgery period. Material and methods: There were included 13 subjects (10 female and 3 male aged between 51 and 78 years old, ready for total hip arthroplasty with uncemented prosthesis. The subjects were selected in Orthopaedics and Traumatology department of Military Clinical Emergency Hospital ”Dr. Victor Popescu” Timisoara. The evaluations regarding programs’ efficiency were made using 3 questionnaires (Oxford Hip Score, Harris Hip Score, Outcome Hip Score and goniometry. The subjects were tested initially before the surgery and 3 times after (at one month, at 3 months and at 6 months. Results: The results showed a remarcable increase for the scores of majority, in both questionnaire and goniometry values. Conclusions: functional rehabilitation exercises proved to be particularly important in regaining independence, control of the prosthetic leg, pain reduction and functional and social reintegration.
Wodowski, Andrew J; Swigler, Colin W; Liu, Hongchao; Nord, Keith M; Toy, Patrick C; Mihalko, William M
Proprioceptive mechanoreceptors provide neural feedback for position in space and are critical for three-dimensional interaction. Proprioception is decreased with osteoarthritis of the knees, which leads to increased risk of falling. As the prevalence of osteoarthritis increases so does the need for total knee arthroplasty (TKA), and knowing the effect of TKA on proprioception is essential. This article reviews the literature regarding proprioception and its relationship to balance, aging, osteoarthritis, and the effect of TKA on proprioception. Knee arthroplasty involving retention of the cruciate ligaments is also reviewed, as well the evidence of proprioception in the posterior cruciate ligament after TKA. Copyright © 2016 Elsevier Inc. All rights reserved.
Kim, Eric G; Patel, Nirav K; Chughtai, Morad; Elmallah, Randa D K; Delanois, Ronald E; Harwin, Steven F; Mont, Michael A
The best strategy to address large bony defects in revision total knee arthroplasty has yet to be determined. The relatively recent development of porous tantalum cones and their use to address massive bone loss in knee arthroplasty has shown promising short- and intermediate-term results. The purpose of this review is to present the current literature on: (1) basic science of porous tantalum, (2) classification and treatment for bone loss, (3) clinical results, and (4) evolution of newer generation cones. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Danoff, Jonathan R.; Geller, Jeffrey A.
The definitive treatment for advanced joint destruction in the late stages of rheumatoid arthritis can be successfully treated with total joint arthroplasty. Total knee arthroplasty has been shown to be a well-proven modality that can provide pain relief and restoration of mobility for those with debilitating knee arthritis. It is important for rheumatologists and orthopedic surgeons alike to share an understanding of the special considerations that must be addressed in this unique population of patients to ensure success in the immediate perioperative and postoperative periods including specific modalities to maximize success. PMID:24151549
Boeckstyns, Michel E H; Herzberg, Guillaume
The results of wrist arthroplasty for severely destroyed and painful wrists are generally good in pain reduction, increased grip strength, and upper limb function. The wrist range of motion is usually preserved but not improved. Implant survival seems better than it was with earlier implant designs; however, there are problems of carpal component loosening. Patient selection plays an important role, requiring experience, careful patient information, and discussing the pros and cons of arthroplasty and partial or total wrist arthrodesis. Copyright © 2017 Elsevier Inc. All rights reserved.
Lindberg-Larsen, Martin; Jørgensen, Christoffer C; Bagger, Jens
Background and purpose - The surgical treatment of periprosthetic knee infection is generally either a partial revision procedure (open debridement and exchange of the tibial insert) or a 2-stage exchange arthroplasty procedure. We describe the failure rates of these procedures on a nationwide...... basis. Patients and methods - 105 partial revisions (100 patients) and 215 potential 2-stage revision procedures (205 patients) performed due to infection from July 1, 2011 to June 30, 2013 were identified from the Danish Knee Arthroplasty Register (DKR). Failure was defined as surgically related death...
For two weeks in August, 1975 more than 140 mathematicians and other scientists gathered at the Universite de Sherbrooke. The occasion was the 15th Biennial Seminar of the Canadian Mathematical Congress, entitled Mathematics and the Life Sciences. Participants in this inter disciplinary gathering included researchers and graduate students in mathematics, seven different areas of biological science, physics, chemistry and medical science. Geographically, those present came from the United States and the United Kingdom as well as from academic departments and government agencies scattered across Canada. In choosing this particular interdisciplinary topic the programme committee had two chief objectives. These were to promote Canadian research in mathematical problems of the life sciences, and to encourage co-operation and exchanges between mathematical scientists" biologists and medical re searchers. To accomplish these objective the committee assembled a stim ulating programme of lectures and talks. Six ...
The Petroleum History Bibliography includes a list of more than 2,000 publications that record the history of the Canadian petroleum industry. The list includes books, theses, films, audio tapes, published articles, company histories, biographies, autobiographies, fiction, poetry, humour, and an author index. It was created over a period of several years to help with projects at the Petroleum History Society. It is an ongoing piece of work, and as such, invites comments and additions.
Hiranandani, Vanmala Sunder
This paper is in response to recent calls to conceptualize and articulate Canadian perspectives and experiences in international social work, given that the Canadian standpoint has been lacking in international social work literature. This paper contends that it is imperative, first of all......, to critically examine and unpack our ‘Canadian’ identity in order to practice international work that is socially just and anti-imperialist. Drawing on the work of post-colonial authors, critical race theorists, and those who study national myth-making, this essay revisits Canadian identity because...... it is this identity that Canadian social workers often carry into their international work....
Dillon, Mark T; Ake, Christopher F; Burke, Mary F; Singh, Anshuman; Yian, Edward H; Paxton, Elizabeth W; Navarro, Ronald A
Shoulder arthroplasty is being performed in the United States with increasing frequency. We describe the medium-term findings from a large integrated healthcare system shoulder arthroplasty registry. Shoulder arthroplasty cases registered between January 2005 and June 2013 were included for analysis. The registry included patient characteristics, surgical information, implant data, attrition, and patient outcomes such as surgical site infections, venous thromboembolism, and revision procedures. During the study period, 6,336 primary cases were registered. Median follow-up time for all primaries was 3.3 years; 461 cases were lost to follow-up by ending of health plan membership. Primary cases were predominantly female (56%) and white (81%), with an average age of 70 years. The most common reason for surgery was osteoarthritis in 60% of cases, followed by acute fracture (17%) and rotator cuff tear arthropathy (15%). In elective shoulder arthroplasty procedures, 200 all-cause revisions (4%) were reported, with glenoid wear being the most common reason. Most arthroplasties were elective procedures: over half performed for osteoarthritis. Glenoid wear was the most common reason for revision of primary shoulder arthroplasty in elective cases.
Over the past twenty years, the question of the effects of violence on television has figured prominently in public opinion and hundreds of studies have been devoted to this subject. Many researchers have determined that violence has a negative impact on behavior. The public, broadcasters and political figures all support the idea of reducing the total amount of violence on television - in particular in shows for children. A thousand programs aired between 1993 and 2001 on major non-specialty television networks in Canada were analyzed: TVA, TQS, as well as CTV and Global, private French and English networks, as well as the English CBC Radio and French Radio-Canada for the public networks. The methodology consists of a classic analysis of content where an act of violence constitutes a unit of analysis. The data collected revealed that the amount of violence has increased regularly since 1993 despite the stated willingness on the part of broadcasters to produce programs with less violence. The total number of violent acts, as well as the number of violent acts per hour, is increasing. Private networks deliver three times more violence than public networks. Researchers have also noted that a high proportion of violence occurs in programs airing before 21:00 hours, thereby exposing a large number of children to this violence. Psychological violence is taking on a more significant role in Canadian Television.
Full Text Available Background. Temporomandibular joint (TMJ ankylosis is a union of the articular surface of the temporal bone to the disc-condyle complex that restricts mandibular movements due to either a fibrous or bony union between the head of the condyle and the glenoid fossa. Common etiological factors are trauma, infection, and pathology in the joint or systemic diseases. The diagnosis of TMJ ankylosis is established through physical and clinical evaluation, and imaging examination. Currently, the surgical techniques used to treat TMJ ankylosis are gap arthroplasty, interpositional arthroplasty, joint reconstruction, and distraction osteogenesis. Purpose. To provide overview about management of temporomandibular joint ankylosis with gap arthroplasty combined with physiotherapy post surgery. Case. A 12-year-old female patient came to Department of Oral and Maxillofacial Surgery with complaint of opening mouth restriction, which occured since one year prior to admission. After complete physical and radiographic examination, patient then was diagnosed with TMJ ankylosis due to neglected odontogenic infection. The treatment was performed with gap arthroplasty under general anesthesia. Patient then underwent physiotherapy after the surgery, including application of heat on the affected region and exercises to open and close mouth. Discussion. Ankylosis of TMJ is an uncommon case that results in chronic and severe limited mouth opening. The critical factor of successful treatment of TMJ ankylosis is early detection, correct surgery approach, implementation of an intensive physiotherapy program, and a good post-operative conduct. Therefore on this patient, gap arthroplasty was the chosen surgery approach followed by intensive physiotherapy. Conclusion.Management goal in TMJ ankylosis is to increase the patient’s mandibular function, correct associated facial deformity, decrease pain, and prevent reankylosis. Careful surgical technique and subsequent atten
Schoch, Bradley; Werthel, Jean-David; Sperling, John W; Cofield, Robert H; Sanchez-Sotelo, Joaquin
Charcot arthropathy is a rare cause of debilitating joint destruction. Shoulder arthroplasty for Charcot arthropathy is challenging secondary to local bone and soft tissue loss, lack of protective sensation, and altered muscle control. The purpose of this study is to review the outcomes, complications, and survivorship of shoulder arthroplasty for Charcot arthropathy. Between January 2000 and December 2011, ten shoulders with Charcot arthropathy were treated with shoulder arthroplasty at our Institution (six hemiarthroplasty, one total shoulder arthroplasty, three reverse shoulder arthroplasty). Shoulders were followed for a minimum of two years or until re-operation. Outcomes measures included pain, range of motion, complications, and reoperation. Shoulder arthroplasty improved pain to a mean score of 2.6 at follow up. However, gains in range of motion were not as substantial, with mean elevation of only 105°. External rotation improved from 20 to 43°. Subjectively, six of the ten patients rated the result as much better or better. Two shoulders underwent revision surgery at an average of five months after index arthroplasty. Shoulder arthroplasty for the treatment of the sequelae of a Charcot joint is a reasonable treatment option to provide substantial pain relief and improved motion. The relative indications of hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty for this particular condition continue to evolve.
Pedersen, Alma Becic; Johnsen, Søren Paaske; Overgaard, Søren
There are few publications regarding the validity of data in hip arthroplasty registers. The Danish Hip Arthroplasty Registry (DHR) is a nationwide clinical database of THAs and revisions in Denmark.......There are few publications regarding the validity of data in hip arthroplasty registers. The Danish Hip Arthroplasty Registry (DHR) is a nationwide clinical database of THAs and revisions in Denmark....
Peterson, L F
Total hip arthroplasty has become an accepted method of management of severe painful problems of the hip. It has undergone some dramatic changes, the major thrust now being to more nearly match the mechanical characteristics of the implant to the bone and cartilage they replace.
Boeckstyns, Michel E H; Herzberg, Guillaume
Background and Literature Review Periprosthetic osteolysis (PPO) after second- or third-generation total wrist arthroplasty (TWA), with or without evident loosening of the implant components, has previously been reported in the literature, but rarely in a systematic way. Purpose The purpose...
Karlsen, Anders Peder Højer; Wetterslev, Mik; Hansen, Signe Elisa
INTRODUCTION: The aim of this systematic review was to document efficacy, safety and quality of evidence of analgesic interventions after total knee arthroplasty (TKA). METHODS: This PRISMA-compliant and PROSPERO-registered review includes all-language randomized controlled trials of medication...
Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B
Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery...
Nilsdotter, Anna K; Toksvig-Larsen, Sören; Roos, Ewa
to pain and physical function after knee arthroplasty. PATIENTS AND METHODS: 102 patients (39 men) with knee osteoarthritis and who were assigned for TKR (mean age 71 (51-86) years) were investigated with KOOS, SF-36, and additional questions concerning physical activity level, expectations, satisfaction...
Mathiesen, Erik B.
The present study concerns late complications after total hip arthroplasty inrelation to implant material, design, and mode of implant fixation. Frictional characteristics inretrieved and new acetabular sockets was studied under dry and lubricated conditionscomparing conventional polyethylene sockets with polyacetal sockets from the Christiansenprosthesis. No difference between new sockets of the two materials was found, whereas thefriction in 12 retrieved polyacetal sockets was significantly...
Schumann, Katrin; Flury, Matthias P; Schwyzer, Hans-Kaspar; Simmen, Beat R; Drerup, Susann; Goldhahn, Joerg
Implant functionality has clearly increased over the past decades because of improvements in total shoulder arthroplasty systems. This means that prostheses are now being implanted in younger patients with high sports activity. The implantation of the total shoulder arthroplasty does not mainly influence the sports activity. Case series; Level of evidence, 4. One hundred consecutive patients with unilateral total shoulder arthroplasty, followed for at least 1 year, were included in the study. Assessment preoperatively and 1 year and 2 years after operation included clinical examination and a validated questionnaire (Constant, Shoulder Pain and Disability Index [SPADI], and Disabilities of the Arm, Shoulder and Hand [DASH] scores, and the Short Form 36 [SF-36]). In addition, all patients received a sports questionnaire developed in house. Of the 55 patients who took part in sports before having shoulder disease, 49 (89%) were still able to participate after a mean follow-up of 2.8 years (range, 1.3-4.6 years). Seventeen patients had given up sports before total shoulder arthroplasty; 11 of them resumed activities after joint replacement but 6 did not start again. No patient had to stop sports because of the total shoulder arthroplasty. The sports most commonly mentioned were swimming (10 patients [20.4%]), golf (8 patients [16.3%]), cycling (8 patients [16.3%]), and fitness training (8 patients [16.3%]). Strength and range of motion, as well as the physical component summary (PCS) of the SF-36 and the Constant score (CS) after total shoulder arthroplasty, were significantly better in the sports group (49 of 100; PCS = 46, CS = 77) than in the nonsports group (45 of 100; PCS = 41,CS = 71). Eighteen patients (36.7%) stated that even after joint replacement, they still suffered restrictions on their sports activities because of shoulder problems. Whereas the overall mean age at follow-up was 68.9 years (range, 26-92 years), the mean age of patients participating in
Gorenoi, Vitali; Schönermark, Matthias P; Hagen, Anja
Man-made joints (joint endoprostheses), including knee endoprostheses, are used in some irreversible diseases of the human joints. The implantation of joint endoprostheses (arthroplasty) is associated with an increased risk for infection. To prevent infections, different interventions without and with the use of antibiotics (hygiene procedures and antibiotic prophylaxis) are used. The benefits of these interventions are not clear yet. The presented report addresses the questions regarding the medical effectiveness, the cost-effectiveness as well as the ethical, social and legal aspects related to the use of interventions to prevent infections after knee arthroplasty. A systematic literature search is conducted in the medical electronic databases MEDLINE, EMBASE, SciSearch etc. in June 2009 and has been completed by a hand search. The analysis includes publications which describe and/or evaluate clinical data from randomized controlled trials (RCT), systematic reviews of RCT, registers of endoprostheses or databases concerning interventions to prevent infections after knee arthroplasty. The conducted literature search also aims to identify health-economic studies and publications dealing explicitly with ethical, social or legal aspects in the use of interventions to prevent infections after knee arthroplasty. The synthesis of information from different publications has been performed qualitatively. The systematic literature search yields 1,030 hits. Based on the predefined inclusion and exclusion criteria a total of ten publications is included in the analysis. The presented report does not find evidence of the effectiveness of different hygiene interventions with a high evidence level. Most of the unspecific interventions are recommended on the basis of results from non-RCT, from studies for other clinical indications and/or for clinically not relevant endpoints, as well as on the basis of expert opinions. The evidence of the effectiveness of intravenous
Full Text Available Scientific background: Man-made joints (joint endoprostheses, including knee endoprostheses, are used in some irreversible diseases of the human joints. The implantation of joint endoprostheses (arthroplasty is associated with an increased risk for infection. To prevent infections, different interventions without and with the use of antibiotics (hygiene procedures and antibiotic prophylaxis are used. The benefits of these interventions are not clear yet. Research questions: The presented report addresses the questions regarding the medical effectiveness, the cost-effectiveness as well as the ethical, social and legal aspects related to the use of interventions to prevent infections after knee arthroplasty. Methods: A systematic literature search is conducted in the medical electronic databases MEDLINE, EMBASE, SciSearch etc. in June 2009 and has been completed by a hand search. The analysis includes publications which describe and/or evaluate clinical data from randomized controlled trials (RCT, systematic reviews of RCT, registers of endoprostheses or databases concerning interventions to prevent infections after knee arthroplasty. The conducted literature search also aims to identify health-economic studies and publications dealing explicitly with ethical, social or legal aspects in the use of interventions to prevent infections after knee arthroplasty. The synthesis of information from different publications has been performed qualitatively. Results: The systematic literature search yields 1,030 hits. Based on the predefined inclusion and exclusion criteria a total of ten publications is included in the analysis. The presented report does not find evidence of the effectiveness of different hygiene interventions with a high evidence level. Most of the unspecific interventions are recommended on the basis of results from non-RCT, from studies for other clinical indications and/or for clinically not relevant endpoints, as well as on the basis of
Hafal (Haval Ahmad
Full Text Available Youth radicalization leading to violence has become a growing fear among Canadians, as terrorist attacks are carried out in Western states. Although Canada has suffered relatively fewer acts of violence, this fear has intensified and a de-radicalization strategy is needed in the Canadian context. In a qualitative case study methodology, interviews were conducted with school counsellors, religious leaders, and academics to explore solutions to youth radicalization. Youth de-radicalization approaches from the United Kingdom were analyzed and found that community-based initiatives were missing from programming. Social identity theory is used to explain that youth join radicalized groups to feel a sense of belonging and have to be provided an alternative and moderate group identity to de-radicalize. This study found youth de-radicalization in Canada is best served through a community collaboration approach.
Henderson, Joanna L; Chaim, Gloria; Luca, Stephanie; Brownlie, E B; Rosenkranz, Susan; Skilling, Tracey A; Beitchman, Joseph H
Concurrent mental health and substance use issues are a serious problem for adolescents and transition-aged youth. Service providers across sectors must be involved in informing system change to meet youth needs. This study examines stakeholder perspectives on services for youth with concurrent disorders including 1) clinical issues in youth services; 2) priority system issues; and 3) optimal knowledge translation strategies to enhance researcher-stakeholder communication. A database of youth clinical services across Canada was developed. Program managers (n = 481) at cross-sectoral (mental health, addictions, justice, child welfare, advocacy, and outreach) youth-serving (aged 12-24) programs were invited to complete an online survey; 232 responded. Survey questions concerned youth needs, program characteristics, priorities for service system enhancement; and usual and preferred knowledge translation methods. Across service sectors, the mean estimated proportion of youth using services with concurrent mental health and substance use problems was 55%. Program managers reported routine screening for mental health and substance use concerns (66%), referring to other agencies to meet the concurrent disorder needs of youth (54%), offering specific programming for concurrent disorders (42%), and program evaluation (48%). Notably, mental health programs were significantly less likely to offer concurrent disorders services than addictions programs. Where services do exist, most are targeted at youth aged 12-18 years, with fewer services available for transition-aged youth. Endorsement of various system change goals exceeded 80%, with a particular emphasis on improving access to services (49%), ensuring a continuum of services for varying levels of severity (37%), and improved integration across sectors (36%). Preferred knowledge exchange methods were workshops and websites for receiving information; and focus groups or surveys, rather than intensive participation on
Cooper, Marcia; Greene-Finestone, Linda; Lowell, Hélène; Levesque, Johanne; Robinson, Stacey
Iron deficiency is the most common nutritional deficiency in the world, but little is known about the iron status of people in Canada, where the last estimates are from 1970-1972. The data are from cycle 2 (2009 to 2011) of the Canadian Health Measures Survey, which collected blood samples from a nationally representative sample of Canadians aged 3 to 79. Descriptive statistics (percentages, arithmetic means, geometric means) were used to estimate hemoglobin and serum ferritin concentrations, and other markers of iron status. Analyses were performed by age/sex group, household income, self-perceived health, diet, and use of iron supplements. World Health Organization reference values (2001) were used to estimate the prevalence of iron sufficiency and anemia. The overall prevalence of anemia was low in the 2009-to-2011 period--97% of Canadians had sufficient hemoglobin levels. Generally, hemoglobin concentration increased compared with 1970-1972; however, at ages 65 to 79, rates of anemia were higher than in 1970-1972. Depleted iron stores were found in 13% of females aged 12 to 19 and 9% of females aged 20 to 49. Lower household income was associated with a lower prevalence of hemoglobin sufficiency, but was not related to lower serum ferritin sufficiency. Self-perceived health and diet were not significantly associated with hemoglobin and serum ferritin levels. The lack of a relationship between iron status and diet may be attributable to the use of questions about food consumption frequency that were not specifically designed to estimate dietary iron intake. Factors other than iron intake might have contributed to the increase in the prevalence of anemia among seniors.
Xu, Yang; Zhu, Yuan; Xu, Xiang-yang
Background Ankle distraction arthroplasty is one option for the treatment of severe ankle arthritis in young patients. The outcomes and factors predicting success in distraction arthroplasty are poorly understood. Methods From January 2011 to May 2015, 16 patients who had undergone ankle distraction arthroplasty for ankle arthritis were operated, including six males and ten females. All patients were available for analysis. The main outcome measurements included joint space on weight bearing ...
Full Text Available Aim: In this paper we describe the physical therapy management of a 64-year-old female following a bilateral hip arthroplasty. Method: The patient featured in this study, after the surgical intervention had undergone specific recovery treatment consisting of: posture techniques, static (isometric contractions and dynamic kinetic techniques (passive motion, passive-actives, actives, actives with resistance, massage, respiratory gymnastics and reeducation of walking. Results: At the end of the rehabilitation program, hip muscular strength and joint range of motion were improved significantly. The Harris hip score was significantly improved, in comparison to the preoperative one. Conclusion: This case illustrates the importance of the rehabilitation management after bilateral hip replacement.
Giaquinto, S; Ciotola, E; Dall'armi, V; Margutti, F
The aim of the study was to evaluate the subjective functional outcome of total hip arthroplasty (THA) in patients who underwent hydrotherapy (HT) 6 months after discharge. A prospective randomized study was performed on 70 elderly inpatients with recent THA, who completed a rehabilitation program. After randomization, 33 of them were treated in conventional gyms (no-hydrotherapy group=NHTG) and 31 received HT (hydrotherapy group=HTG). Interviews with the Western-Ontario MacMasters Universities Osteoarthritis Index (WOMAC) were performed at admission, at discharge and 6 months later. Kruskal-Wallis, Mann-Whitney and Wilcoxon tests were applied for statistical analysis. Both groups improved. Pain, stiffness and function were all positively affected. Statistical analysis indicated that WOMAC sub-scales were significantly lower for all patients treated with HT. The benefits at discharge still remained after 6 months. We conclude that HT is recommended after THA in a geriatric population.
Waterman, Brian R; Belmont, Philip J; Bader, Julia O; Schoenfeld, Andrew J
Current indices fail to consistently predict risk for major adverse cardiac events after major total joint arthroplasty. All primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) were identified from the National Surgical Quality Improvement Program data set. Based on prior analyses, age ≥80 years, history of hypertension, and history of cardiac disease were evaluated as predictors of myocardial infarction and cardiac arrest using stepwise multivariate logistic regression. A series of predictive scores were constructed and weighted to identify the influence of each variable on 30-day postoperative cardiac events, while comparing with the Revised Cardiac Risk Index (RCRI). Among 85,129 patients, age ≥80 years, hypertension, and a history of cardiac disease were all statistically significant predictors of postoperative cardiac events (0.32%; n = 275) after TKA and THA (P ≤ .02). Equal weighting of all variables maintained the highest discriminative capacity in both THA and TKA cohorts. Adjusted models explained 75% and 71% of the variation in postoperative cardiac events for those with THA and TKA, respectively, without statistically significant lack of fit (P = .52; P = .23, respectively). Conversely, the RCRI was not a significant predictor of postoperative cardiac events after TKA (odds ratio, 3.36; 95% CI, 0.19, 58.04; P = .40), although it maintained a similar discriminative capacity after THA (76%). The current total joint arthroplasty Cardiac Risk Index score was the most economical in predicting postoperative cardiac complication after primary unilateral TKA and THA. The RCRI was not a significant predictor of perioperative cardiac events for TKA patients but performed similarly to the current model for THA. Copyright © 2015 Elsevier Inc. All rights reserved.
Neufeld, Anastasia; Westerberg, Brian D; Nabi, Shahin; Bryce, Graham; Bureau, Yves
To assess the efficacy of a hearing conservation program in changing acoustic risk-taking and hearing conservation behaviors in elementary school children. Prospective, randomized, mixed design controlled study. Participants were grade-six students from 16 Vancouver School Board schools. Differences between the intervention and control group responses on a behavioral questionnaire were measured at baseline, and then at 2 weeks and 6 months after administration of a hearing conservation program (Sound Sense™). The intervention resulted in significant interactions for improved earplug use at dances (P = .019), rock concerts (P = .001), with percussion musical instruments (P = .002), and electric guitars (P = .028) at 2 weeks postintervention relative to baseline. Improvements in children's earplug use at dances (P = .041), rock concerts (P = .0024), and with power lawn mowers (P = .043) at 6 months postintervention relative to baseline were also observed. Behavior in the intervention group compared to control group improved in earplug use with any "other noises" at 2 weeks (P = .001), and 6 months (P = .022) relative to baseline. There was a tendency in the intervention group to reduce the duration of use of personal music devices at 2 weeks and 6 months after the hearing conservation program, which was nonsignificant. The Sound Sense™ hearing conservation program improved earplug use practices in elementary school children in the short and long term. The development, implementation and evaluation of a community-based health promotion project around hearing loss can serve as a tremendous opportunity for students to develop their knowledge and skills in health advocacy.
Farquhar, Robin H.
In a background statement identifying what is unique about Canada and the issues it currently faces, this paper begins by discussing the concurrent movements toward Canadian nationalism and Quebec nationalism as an illustration of the problems caused by large size and great diversity. It then focuses on unique aspects of Canadian education,…
Harvey, I A; Barry, K; Kirby, S P; Johnson, R; Elloy, M A
We have investigated those factors which influence the range of movement after total knee arthroplasty, including sex, age, preoperative diagnosis and preoperative flexion deformity and flexion range...
Tremblay, Mark S; Feng, Min; Garriguet, Didier; Ball, Geoff D C; Buchholz, Annick; Chanoine, Jean-Pierre; Lambert, Marie; Morrison, Katherine M
A pilot study was conducted to assess the feasibility of establishing a multi-site CANadian Pediatric Weight management Registry (CANPWR) containing individual, family and weight management program information. Standardized baseline data were collected to characterize CANPWR participants (n = 310) in comparison to a sample of age-matched Canadian children measured in the nationally representative Canadian Health Measures Survey (CHMS; n = 3,788). This study compared demographic, anthropometric, cardiometabolic and lifestyle characteristics of participants (aged 6-17 years) in the CANPWR pilot study with those from the CHMS. Compared to CHMS respondents, CANPWR participants had higher BMI z-score, waist circumference, blood pressure, total cholesterol, LDL cholesterol, triglycerides and fasting glucose, and lower HDL cholesterol. They reported lower sugared drink consumption, were more likely to be non-white and had parents with lower education. The CANPWR cohort represents a group that has biological and behavioral profiles that place them at increased health risk and who differ significantly from typical Canadians of the same age.
VanderBurgh, D; Jamieson, R; Beardy, J; Ritchie, S D; Orkin, A
Community-based first aid training is the collaborative development of locally relevant emergency response training. The Sachigo Lake Wilderness Emergency Response Education Initiative was developed, delivered, and evaluated through two intensive 5-day first aid courses. Sachigo Lake First Nation is a remote Aboriginal community of 450 people in northern Ontario, Canada, with no local paramedical services. These courses were developed in collaboration with the community, with a goal of building community capacity to respond to medical emergencies. Most first aid training programs rely on standardized curriculum developed for urban and rural contexts with established emergency response systems. Delivering effective community-based first aid training in a remote Aboriginal community required specific adaptations to conventional first aid educational content and pedagogy. Three key lessons emerged during this program that used collaborative principles to adapt conventional first aid concepts and curriculum: (1) standardized approaches may not be relevant nor appropriate; (2) relationships between course participants and the people they help are relevant and important; (3) curriculum must be attentive to existing informal and formal emergency response systems. These lessons may be instructive for the development of other programs in similar settings.
Rosenstein, Barry S; Held, Kathryn D; Rockwell, Sara; Williams, Jacqueline P; Zeman, Elaine M
To obtain, in a survey-based study, detailed information on the faculty currently responsible for teaching radiation biology courses to radiation oncology residents in the United States and Canada. In March-December 2007 a survey questionnaire was sent to faculty having primary responsibility for teaching radiation biology to residents in 93 radiation oncology residency programs in the United States and Canada. The responses to this survey document the aging of the faculty who have primary responsibility for teaching radiation biology to radiation oncology residents. The survey found a dramatic decline with time in the percentage of educators whose graduate training was in radiation biology. A significant number of the educators responsible for teaching radiation biology were not fully acquainted with the radiation sciences, either through training or practical application. In addition, many were unfamiliar with some of the organizations setting policies and requirements for resident education. Freely available tools, such as the American Society for Radiation Oncology (ASTRO) Radiation and Cancer Biology Practice Examination and Study Guides, were widely used by residents and educators. Consolidation of resident courses or use of a national radiation biology review course was viewed as unlikely by most programs. A high priority should be given to the development of comprehensive teaching tools to assist those individuals who have responsibility for teaching radiation biology courses but who do not have an extensive background in critical areas of radiobiology related to radiation oncology. These findings also suggest a need for new graduate programs in radiobiology.
Evren, Sevan; Bi, Andrew Yuzhong; Talwar, Shuchi; Yeh, Andrew; Teitelbaum, Howard
Doctors of osteopathic medicine (DO) are one of the fastest growing segments of health care professionals in the United States. Although Canada has taken significant leaps in the acknowledgment of US trained DOs, there continues to be a lack of understanding of the profession by Canadian trained physicians. In this article, we provide a brief overview of osteopathic medical education and training in the United States. Current information of osteopathic training by American Association of Colleges of Osteopathic Medicine (AACOM) and American Osteopathic Association (AOA) was presented. Data pertaining to Canadians enrolled in osteopathic colleges was compared with allopathic (MD) and international medical graduates (IMGs). Doctors of osteopathic medicine programs provide an additional pathway for students interested in pursuing a medical education. Canadian applications to osteopathic colleges are expected to grow due to successful post-graduate US residency matching, increased difficulty of matriculating at Canadian medical schools, and a greater awareness of the profession in Canada. Given the increasing enrollment of Canadian students in US osteopathic medical schools, we expect that Canadian DOs will play a significant role in shaping health care in both the US and Canada.
Slater, Joyce J; Mudryj, Adriana N
This study identified and described Canadians' self-perceived eating habits and food skills through the use of population-based data. Data from the Canadian Community Health Survey 2013 Rapid Response on Food Skills was used to examine the eating quality and patterns of Canadians. Data were collected from all provinces in January and February 2013. Respondent variables (sex, age, Aboriginal/immigrant status) were examined to assess differentiations between socio-demographic groupings (family structure, marital status, education, and income). Logistic regression was used to determine whether demographic variables increased the likelihood of certain responses. Forty-six percent of Canadians believe they have excellent/very good eating habits, with 51% categorizing their habits as good or fair. Similarly, the majority report having good food skills. Sex and age were significantly associated with food skills, with women rating their cooking skill proficiency higher than men (72% vs 55%), and older Canadians reporting higher food skill knowledge than their younger counterparts. Results indicate that while portions of the Canadian population have adequate food skills, others are lacking, which may negatively impact their diet. Findings from this study have implications for education and health promotion programs focusing on foods skills, particularly among vulnerable target groups. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
Liljensøe, A.; Laursen, J. O.; Bliddal, H.
to implement an intensive weight loss program in order to reduce preoperative body weight of obese patients before TKA surgery. The primary aim of the Weight Loss Intervention before Total Knee Arthroplasty (WITKA) study is to investigate whether weight loss interventions before total knee arthroplasty (TKA...... or a weight loss group that followed a low-energy diet (810 kcal/day) 8 weeks before surgery. Outcomes were assessed before intervention for the weight loss group, and within 1 week preoperatively for both the weight loss group and the control group. The primary outcome in the WITKA study was the Short......-Form 36 (SF-36). Secondary outcomes were Knee injury and Osteoarthritis Outcome Score (KOOS), 6 Minutes' Walk Test, and body composition. Results: Included were 77 patients (weight loss group n=38; control group n=39), 71% were females, the mean age was 65 years (range 46-85), and the average BMI was 31...
Bamsey, M.; Graham, T.; Stasiak, M.; Berinstain, A.; Scott, A.; Vuk, T. Rondeau; Dixon, M.
applications). To advance the technical readiness for the proposed lunar missions, including a lunar plant growth lander, lunar "salad machine" (i.e. small scale plant production unit) and a full scale lunar plant production system, a suite of terrestrial developments and analogue systems are proposed. As has been successfully demonstrated by past Canadian advanced life support activities, terrestrial technology transfer and the development of highly qualified personnel will serve as key outputs for Canadian advanced life support system research programs. This approach is designed to serve the Canadian greenhouse industry by developing compliance measures for mitigating environmental impact, reducing labour and energy costs as well as improving Canadian food security, safety and benefit northern/remote communities.
Ekelund, Anders L
Even though reverse shoulder arthroplasty is a very successful procedure, painful complications occur. During the initial postoperative years, the most common reasons for pain are instability, postoperative fracture of the acromion or spine, and periprosthetic infection. Later, aseptic loosening, with humeral loosening being more frequent that glenoid loosening, can be a source of pain and reduction in function. A careful patient history, clinical examination, plain radiographs, computed tomography and blood tests give an explanation for the pain in most cases. The majority of these complications can be successfully treated, maintaining a functional reverse shoulder arthroplasty. However, if all examinations are normal, it is important to remember that nonshoulder conditions such as tumour of the lung or degenerative changes of the cervical spine can give shoulder pain.
Matthew J. Teusink
Full Text Available Cost in shoulder surgery has taken on a new focus with passage of the Patient Protection and Affordable Care Act. As part of this law, there is a provision for Accountable Care Organizations (ACOs and the bundled payment initiative. In this model, one entity would receive a single payment for an episode of care and distribute funds to all other parties involved. Given its reproducible nature, shoulder arthroplasty is ideally situated to become a model for an episode of care. Currently, there is little research into cost in shoulder arthroplasty surgery. The current analyses do not provide surgeons with a method for determining the cost and outcomes of their interventions, which is necessary to the success of bundled payment. Surgeons are ideally positioned to become leaders in ACOs, but in order for them to do so a methodology must be developed where accurate costs and outcomes can be determined for the episode of care.
Cansu Benli Işık
Full Text Available Metallic prosthetic materials are used in place of bones and joints that have lost their function. Metallosis is a rare complication of the arthroplasty where metallic prostheses are used. It is defined as the infiltration of friction-related metallic debris into periprosthetic bones and soft tissues. Its histology is characterized by widespread lymphoplasmacytic and histiocytic infiltration around metal debris, foreign body giant cells, metal particles, extracellular metal deposits and intracytoplasmic debris in giant cells. Since it can be confused with malignant melanoma due to the presence of pigment as well as, giant cell tumors of the soft tissues and bones, care should be taken in the examination of post-arthroplastic materials. For this reason, we found it worthwhile to present two rare cases of post-arthroplasty metallosis, one developed in the knee joint and the other in the hip joint.
Kjaersgaard-Andersen, P.; Frich, Lars Henrik; Sjøbjerg, J.O.
The incidence and location of heterotopic bone formation following total shoulder arthroplasty were evaluated in 58 Neer Mark-II total shoulder replacements. One year after surgery, 45% had developed some ectopic ossification. In six shoulders (10%) the ossifications roentgenographically bridged...... the glenohumeral and/or the glenoacromial space. There was no correlation between shoulder pain and the development of ossification. Shoulders with grade III heterotopic bone formation had a limited range of active elevation compared with shoulders without or with only a milder lesion. Men and patients...... with osteoarthritis of the shoulder joint were significantly disposed to the development of heterotopic bone. Heterotopic bone formation following total shoulder arthroplasty is frequent, but disabling heterotopic ossifications seem to be rare....
Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B
Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery....... Methods 29 patients were operated with 30 revision arthroplasties. Median age was 67 (34-84) years. All patients followed a standardized fast-track set-up designed for primary TKA. We determined the outcome regarding LOS, morbidity, mortality, and satisfaction. Results Median LOS was 2 (1-4) days...... undergoing revision TKA for non-septic reasons may be included in fast-track protocols. Outcome appears to be similar to that of primary TKA regarding LOS, morbidity, and satisfaction. Our findings call for larger confirmatory studies and studies involving other indications (revision THA, 1-stage septic...
Thromboembolic events are a post-operative complication of arthroplasty surgery for up to 3 months. The incidence however, is not fully known. Some form of prophylaxis should be provided to all arthroplasty patients. Clinicians are wary of side effects, compliance profile and the associated cost. The objective of this study is to investigate practice patterns and their relevance to 3 risk groups. Ninety questionnaires were sent to orthopaedic surgeons with 3 hypothetical clinical scenarios and 10 prophylaxis regimes for thromboembolism across different risk groups. The response rate was 81\\/90 (90%). The most popular options in all 3 cases were early mobilisation, thrombo-embolism deterrant (TED) stockings and low molecular weight heparin (LMWH) (51\\/81, 62% of all cases). An inconsistent relationship exists between preferred practice and relevant guidelines. Preferred practice does not correlate with each level of risk.
van der Plaat LW; Haverkamp D
Laurens W van der Plaat,1 Daniël Haverkamp2 1Department of Orthopaedic Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands; 2Slotervaart Center of Research and Education (SCORE), MC Slotervaart Hospital, Amsterdam, the Netherlands Abstract: Total ankle arthroplasty is a treatment option for end-stage osteoarthritis of the ankle, as is ankle arthrodesis. Many variables, including patient characteristics, are thought to influence clinical outcome and survival. As with any surg...
Morinville, Véronique; Drouin, Éric; Lévesque, Dominique; Espinosa, Victor M; Jacobson, Kevan
BACKGROUND: There is concern that the Canadian pediatric gastroenterology workforce is inadequate to meet health care demands of the pediatric population. The Canadian Association of Gastroenterology Pediatric Committee performed a survey to determine characteristics and future plans of the Canadian pediatric gastroenterology workforce and trainees. METHODS: Estimates of total and pediatric populations were obtained from the 2001 Census of Population, Statistics Canada (with estimates to July 1, 2005). Data on Canadian pediatric gastroenterologists, including clinical full-time equivalents, sex, work interests, opinions on workforce adequacy, retirement plans, fellowship training programs and future employment plans of fellows, were gathered through e-mail surveys and telephone correspondence in 2005 and 2006. RESULTS: Canada had an estimated population of 32,270,507 in 2005 (6,967,853 people aged zero to 17 years). The pediatric gastroenterology workforce was estimated at 9.2 specialists per million children. Women accounted for 50% of the workforce. Physician to pediatric population ratios varied, with Alberta demonstrating the highest and Saskatchewan the lowest ratios (1:69,404 versus 1:240,950, respectively). Between 1998 and 2005, Canadian pediatric gastroenterology fellowship programs trained 65 fellows (65% international trainees). Twenty-two fellows (34%) entered the Canadian workforce. CONCLUSIONS: The survey highlights the variable and overall low numbers of pediatric gastroenterologists across Canada, an increasingly female workforce, a greater percentage of part-time physicians and a small cohort of Canadian trainees. In conjunction with high projected retirement rates, greater demands on the work-force and desires to partake in nonclinical activities, there is concern for an increasing shortage of pediatric gastroenterologists in Canada in future years. PMID:17948136
The Canadian Space Agency, Space Station, Strategic Technologies for Automation and Robotics Program technology development activity in protection of materials from the low Earth orbit space environment
Francoeur, J. R.
The Strategic Technologies in Automation and Robotics (STEAR) program is managing a number of development contracts to improve the protection of spacecraft materials from the Low Earth Orbit (LEO) space environment. The project is structured in two phases over a 3 to 4 year period with a budget of 3 to 4 million dollars. Phase 1 is designed to demonstrate the technical feasibility and commercial potential of a coating/substrate system and its associated application process. The objective is to demonstrate a prototype fabrication capability using a full scale component of a commercially viable process for the protection of materials and surface finishes from the LEO space environment, and to demonstrate compliance with a set of performance requirements. Only phase 1 will be discussed in this paper.
Sarmah, SS; Patel, S; Reading, G; El-Husseiny, M; Douglas, S; Haddad, FS
INTRODUCTION The number of total knee arthroplasties performed continues to rise annually and it would be expected that complications, which include periprosthetic fractures, will also therefore become more commonplace. This article reviews the current literature regarding this injury and identifies the treatment principles that enable patients to regain optimal function. METHODS A comprehensive search of the Pubmed and Embase™ databases was performed to identify relevant articles. Keywords and MeSH (Medical Subject Headings) terms included in the search strategy were ‘periprosthetic fracture(s)’, ‘femur’, ‘tibia’, ‘patella(r)’, ‘complication(s)’, ‘failure(s)’, ‘risk(s)’, ‘prevalence’, ‘incidence’, ‘epidemiology’ and ‘classification(s)’. The search was limited to all articles published in English and reference lists from the original articles were reviewed to identify pertinent articles to include in this review. A total number of 43 studies were identified. RESULTS Common treatment aims have been identified when managing patients with a periprosthetic fracture around total knee arthoplasty. The main criterion that determines which option to choose is the degree of remaining bone stock and the amount of fracture displacement. CONCLUSIONS Treatment of a periprosthetic fracture around total knee arthroplasty will either be non-operative, osteosynthesis or revision arthroplasty. It is imperative that a suitable option is chosen and based on the published literature, pathways are outlined to aid the surgeon. PMID:22943223
Kim, Nam Ki
Periprosthetic fractures after total knee arthroplasty may occur in any part of the femur, tibia and patella, and the most common pattern involves the supracondylar area of the distal femur. Supracondylar periprosthetic fractures frequently occur above a well-fixed prosthesis, and risk factors include anterior femoral cortical notching and use of the rotational constrained implant. Periprosthetic tibial fractures are frequently associated with loose components and malalignment or malposition of implants. Fractures of the patella are much less common and associated with rheumatoid arthritis, use of steroid, osteonecrosis and malalignment of implants. Most patients with periprosthetic fractures around the knee are the elderly with poor bone quality. There are many difficulties and increased risk of nonunion after treatment because reduction and internal fixation is interfered with by preexisting prosthesis and bone cement. Additionally, previous soft tissue injury is another disadvantageous condition for bone healing. Many authors reported good clinical outcomes after non-operative treatment of undisplaced or minimally displaced periprosthetic fractures; however, open reduction or revision arthroplasty was required in displaced fractures or fractures with unstable prosthesis. Periprosthetic fractures around the knee should be prevented by appropriate technique during total knee arthroplasty. Nevertheless, if a periprosthetic fracture occurs, an appropriate treatment method should be selected considering the stability of the prosthesis, displacement of fracture and bone quality. PMID:25750888
Falez, Francesco; Papalia, Matteo; Favetti, Fabio; Panegrossi, Gabriele; Casella, Filippo; Mazzotta, Gianluca
Hip dislocation is a major and common complication of total hip arthroplasty (THA), which appears with an incidence between 0.3% and 10% in primary total hip arthroplasties and up to 28% in revision THA. The hip dislocations can be classified into three groups: early, intermediate and late. Approximately two-thirds of cases can be treated successfully with a non-operative approach. The rest require further surgical intervention. The prerequisite to developing an appropriate treatment strategy is a thorough evaluation to identify the causes of the dislocation. In addition, many factors that contribute to THA dislocation are related to the surgical technique, mainly including component orientation, femoral head diameter, restoration of femoral offset and leg length, cam impingement and condition of the soft tissues. The diagnosis of a dislocated hip is relatively easy because the clinical situation is very typical. Having identified a dislocated hip, the first step is to perform a closed reduction of the implant. After reduction you must perform a computed tomography scan to evaluate the surgical options for treatment of recurrent dislocation that include: revision arthroplasty, modular components exchange, dual-mobility cups, large femoral heads, constrained cups, elimination of impingement and soft tissue procedures. The objective is to avoid further dislocation, a devastating event which is increasing the number of operations on the hip. To obtain this goal is useful to follow an algorithm of treatment, but the best treatment remains prevention.
This dissertation explores and discusses different aspects of blood loss and blood-saving measures in total hip and knee arthroplasty. Background: Worldwide, approximately 1 million total hip and 1 million total knee prostheses are implanted each year. Total hip arthroplasty and total
Husted, Henrik; Jensen, Tim Toftgaard
Twenty-six consecutive cases of infected primary total knee arthroplasties were treated at our institution from 1989 through 2000. Eleven patients had debridement and irrigation performed within 2 months of index arthroplasty or hematogenous spread; only one infection was eradicated. Twenty-five ...
Koppens, Daan; Stilling, Maiken; Munk, Stig
The purpose of this study was to evaluate implant migration of the fixed-bearing Sigma® medial unicompartmental knee arthroplasty (UKA). UKA is a regularly used treatment for patients with medial osteoarthritis (OA) of the knee. UKA has a higher revision rate than total knee arthroplasty. Implant...... migration can be used as a predictor of implant loosening....
Larsen, Kristian; Hansen, Torben Bæk; Søballe, Kjeld
PURPOSE: The purpose of this study was to describe patient-related functional outcomes after fast-track total knee arthroplasty and unicompartmental knee arthroplasty. Furthermore, we wanted to assess physical areas where an additional need for rehabilitation could be identified, and finally, we...
Arthroplasty is an established management of various joint disorders in developed countries. Poverty has caused African countries to remain behind in this sphere of management and condemned sufferers to a life of misery and immobility. In this review, the viability of total hip arthroplasty (THR) is examined. The need ...
Kin Weng Wong
Conclusion: Our technique (distraction arthroplasty without trapeziectomy preserves bony and adjacent structures. It is easier and quicker than traditional arthroplasties. It serves as another effective and stable method of tendon reconstruction with a less invasive approach. A larger series is needed for further observation of validity of the procedure.
Colwell, Clifford W; Hozack, William J; Mesko, J Wesley; D'Antonio, James A; Bierbaum, Benjamin E; Capello, William N; Jaffe, William L; Mai, Kenny T
Wear debris from metal-on-polyethylene articulation in conventional total hip arthroplasty can limit the implant's longevity. Modern ceramic material with high wear resistance and low fracture risk has the potential to extend the lifetime of total hip arthroplasty, which makes the procedure potentially more suitable for young, active patients. Concerns with brittle ceramic material include fracture risk, the "squeak" phenomenon, and potentially a higher dislocation rate secondary to limited neck lengths and liner options. We therefore determined the early dislocation rate in modern ceramic-on-ceramic total hip arthroplasty. In 1635 total hip arthroplasties performed over the 9-year period (1996-2005), we observed three anterior and 15 posterior dislocations (1.1%). All were treated successfully, one with a revision and 17 with closed reduction under general anesthesia. Ceramic-on-ceramic total hip arthroplasty can be a good alternative bearing surface with a low dislocation rate.
Strunk, S; Bracker, W
The advantage of wrist arthroplasty remains controversial, primarily due to the high complication rate. For this reason it seems sensible to monitor the results of different types of prostheses even with small numbers of cases. We were particularly interested to see if wrist joint arthroplasty is a useful alternative for patients with rheumatoid arthritis, and which of the types we used shows the best results. In our hospital, 41 wrist joint prostheses (15 Meuli, 16 BIAX and 10 Universal 2) were implanted in 36 patients from 1992 until 2005 (follow-up 1 to 14 years, mean 5.3 years). 33 patients had rheumatic destruction of the wrist, two had osteoarthritis following fracture of the scaphoid, and one pseudarthrosis after failed arthroplasty and arthrodesis for Kienböck's disease. Mean age was 54 years, ranging from 34 to 73 years. 14 patients had had surgery on this wrist before. The patients were sent a questionnaire including the DASH score, and a clinical evaluation and X-rays were performed. 33 patients with 38 wrist arthroplasties answered the questionnaire, 34 wrist joint prosthesis of 29 patients could be evaluated. 6 prostheses had to be removed because of complications (3 arthrodeses were performed after removal, 3 prostheses were exchanged). There were 4 dislocations (3 times with the Meuli type, once with the BIAX type). There was one case of CRPS type I. But subjectively, in answering our questionnaire, 31 of 38 patients claimed to be very satisfied or satisfied with the result of the operation, only 6 were less satisfied or not satisfied at all. An improvement of pain was found by all but one patient. An increase in strength or range of movement was found more rarely. The mean postoperative DASH score was 61 points. Mean wrist joint mobility was 50 degrees for extension/flexion, and 20 degrees for radial- and ulnar abduction. The result of total wrist joint arthroplasty depends very much on a careful patient selection. A preoperative bony malposition
Full Text Available Introduction: Total knee arthroplasty (TKA offers high survival and high functional scores when arthritis is affecting the three compartments of the knee; however, TKA does not preserve the bone stock and the ligaments and these points can represent theoretical disadvantages, particularly for young patients with higher demand and higher risk for potential revision. Bicompartmental knee arthroplasty (BKA is a type of resurfacing surgery where two of the three compartments of the knee joint (medial tibiofemoral, lateral tibiofemoral or patellofemoral are replaced with preservation of the third. Smaller implant sizes, less operative trauma, preservation of both cruciate ligaments and bone stock, and a more ‘‘physiological’’ knee are reported advantages over TKA. BKA has been proposed to bridge the gap between UKA and TKA. Methods: A systematic literature search was conducted during May and June 2014. The electronic databases searched were: PUBMED/MEDLINE and Cochrane Library. No language or data restrictions were used. The search keyword was bicompartmental knee artroplasty, BKA, unicompartmental knee arthroplasty AND patellofemoral arthroplasty, unicompartmental knee arthroplasty AND patellofemoral joint, UKA AND PFJ, which appeared in the title, abstract or keyword fields. Initially, 129 articles were found: based on abstract and after removal of duplicates, 102 articles remained. The full text of each of these articles was read and another 13 articles were considered non-relevant and removed. The final number of articles included in this review was 89. Results: Functional and radiological results, complication, survivorship, kinematics and advantages of BKA versus TKA were analyzed. Discussion and Conclusion: Advantages of a bonesparing, ligament-sparing, such as BKA, are clearly evident. It seems intuitive that a knee reconstruction that maintains the proprioceptive and kinematic benefits of retaining the cruciate ligaments would be
US Fish and Wildlife Service, Department of the Interior — The mandate of the CNVC is to comprehensively classify and describe natural and semi-natural Canadian vegetation in an ecologically meaningful manner. The...
Spitzer, Denise L
.... What contributes to this deterioration, and how can its effects be mitigated? Engendering Migrant Health brings together researchers from across Canada to address the intersections of gender, immigration, and health in the lives of new Canadians...
Naughton, Donna; Banfield, A. W. F
.... A complete revision of A.W.F. Banfield's classic text Mammals of Canada, it features brand-new, full-colour images of each species, as well as stunning photographs from Canadian Geographic magazine's national photography...
Spitzer, Denise L
"Voluntary migrants to Canada are generally healthier than the average Canadian, but after ten years in the country they report poorer health and higher rates of chronic disease than those born here...
Amin, Reshma; Sayal, Aarti; Syed, Faiza; Daniels, Cathy; Hoffman, Andrea; Moraes, Theo J; Cox, Peter
To assess the length of stay required to initiate long-term invasive ventilation at the authors' institution, which would inform future interventional strategies to streamline the in-hospital stay for these families. A retrospective chart review of children initiated on invasive long-term ventilation via tracheostomy at the authors' acute care centre between January 2005 and December 2013 was performed. Thirty-five children were initiated on long-term invasive ventilation via tracheostomy at the acute care hospital; 19 (54%) were male. The median age at time of admission was 0.52 years (interquartile range [IQR] 0.06 to 9.58 years) . Musculoskeletal disease (n=11 [31%]) was the most common reason for tracheostomy insertion. Two children died during the hospital admission. Fifteen children were discharged home directly from the acute care hospital and 18 were moved to the rehabilitation hospital. Six are current inpatients of the rehabilitation centre and were never discharged home. Combining the length of stay at the acute care and rehabilitation hospitals for the entire cohort, the median length of stay was 162.0 days (IQR 98.0 to 275.0 days) and 97.0 days (IQR 69.0 to 210.0 days), respectively, from the time of tracheostomy insertion. The median length of stay from the initiation of invasive long-term ventilation to discharge home from the rehabilitation hospital was somewhat long compared with other ventilation programs worldwide. Additionally, approximately 20% of the cohort never transitioned home. There is a timely need to benchmark across the country and internationally, to identify and implement strategies for cohesive, coordinated care for these children to decrease overall length of stay.
The, B.; Verdonschot, N.J.J.; Horn, J.R. van; Ooijen, PM van; Diercks, R.L.
The objective of this randomized clinical trial was to compare the clinical and technical results of digital preoperative planning for primary total hip arthroplasties with analogue planning. Two hundred and ten total hip arthroplasties were randomized. All plans were constructed on standardized
The, Bertram; Verdonschot, Nico; van Horn, Jim R.; van Ooijen, Peter M. A.; Diercks, Ron L.
The objective of this randomized clinical trial was to compare the clinical and technical results of digital preoperative planning for primary total hip arthroplasties with analogue planning. Two hundred and ten total hip arthroplasties were randomized. All plans were constructed on standardized
Bachman, Daniel; Nyland, John; Krupp, Ryan
To compare reverse-total shoulder arthroplasty (RSA) cost-effectiveness with total hip arthroplasty cost-effectiveness. This study used a stochastic model and decision-making algorithm to compare the cost-effectiveness of RSA and total hip arthroplasty. Fifteen patients underwent pre-operative, and 3, 6, and 12 mo post-operative clinical examinations and Short Form-36 Health Survey completion. Short form-36 Health Survey subscale scores were converted to EuroQual Group Five Dimension Health Outcome scores and compared with historical data from age-matched patients who had undergone total hip arthroplasty. Quality-adjusted life year (QALY) improvements based on life expectancies were calculated. The cost/QALY was $3900 for total hip arthroplasty and $11100 for RSA. After adjusting the model to only include shoulder-specific physical function subscale items, the RSA QALY improved to 2.8 years, and its cost/QALY decreased to $8100. Based on industry accepted standards, cost/QALY estimates supported both RSA and total hip arthroplasty cost-effectiveness. Although total hip arthroplasty remains the quality of life improvement "gold standard" among arthroplasty procedures, cost/QALY estimates identified in this study support the growing use of RSA to improve patient quality of life.
Munby, Hugh; Hutchinson, Nancy; Chin, Peter
Research on co-op education in Canadian secondary schools indicates that it was under-appreciated in ministry policy. However, participants felt that cooperative education was a career exploration opportunity, contextualized the academic curriculum, taught work ethics, and prepared students for postsecondary programs. A clearer commitment to…
Saari, J.; And Others
A study of safety training programs in 66 Canadian companies found that those who provided tailor-made training already offered better working conditions, greater management involvement in safety work, and more safety activities than those who used outside training sources. This suggests that safety regulations benefit good companies more than…
Webber, Charles F.; Scott, Shelleyann
This article reports the entrepreneurial activities of two university faculties, one Canadian and the other Australian, that were designed to meet the educational needs of students and to garner the resources necessary for program delivery. A conceptual framework for educational entrepreneurship, containing six dimensions, is proposed. The…
Vladimir E. Baskov
Full Text Available Introduction. Treating children with degenerative dystrophic diseases of the hip joint has become one of the most acute problems in contemporary orthopedics. Until recently, we performed arthroplasty by demineralized bone-cartilage allocups (DBCA in the Clinic of the Hip Joint Pathology of the Turner Scientific and Research Institute for Children’s Orthopedics for patients showing clinical and radiological signs of irreversible destruction of the hip joint; we carried out this procedure to preserve the function of the lower limb. However, over the last 8 years, we have changed our protocol for children older than 12 years of age and have replaced DBCA with total hip replacement. In a number of cases, total hip replacement was performed after a previous intervention involving arthroplasty with DBCA. Objective. To determine the technical peculiarities of total hip replacement after a previous intervention involving arthroplasty with DBCA. Material and methods. We analyzed the results of treatment involving various types of hip pathology in 13 children (100% aged between 15 and 16 years [8 girls (61.5% and 5 boys (38.5%]. The medical histories of all 13 children (100% showed repeated operations on the hip joint, ultimately resulting in arthroplasty with DBCA. All 13 children (100% underwent a total hip replacement. Upon hip replacement, all 13 patients (100% showed a pronounced thinning and hardening of the edges and the bottom of the acetabulum, which created some difficulties in the process of acetabular component implantation. The transformation of DBCA was not evident in any of the 13 cases (100%. Results. During the observation period of 3–5 years following total hip arthroplasty, all 13 cases (100% showed recovery in the range of motion and absence of pain. An important criterion for evaluating the quality of care was the complete social and domestic adaptation of all 13 children (100% during the period from 6 to 9 months following total
Canada's energy is complex and an important resource as it fuels and funds the economy. The unique character of Canada's energy production and consumption provides strength to the country. The purpose of this booklet was to highlight Canada's energy production and consumption and to demonstrate Canada's rank globally with other major global energy players. The document also presented information on the value of Canada's energy exports, Canada's relationship with the United States, and Canada's energy-related carbon dioxide emissions. Specifically, the document discussed Canada's energy in a global context; the value of Canada's energy exports; domestic value of energy; Canada's unique energy mix; Canada's electricity mix; Canada's carbon dioxide emissions; energy strategies; and the importance of energy to Canadians. It was concluded that there are 14 federal, provincial and territorial jurisdictions managing their respective energy resources. All of these regions, with the exception of Saskatchewan have produced an energy strategy document or a climate change action plan focusing on 8 areas of action, notably awareness; benefit; efficiency; development; diversification; electricity; and emissions. refs., tabs., figs.
Kudlow, Paul A; Naylor, Karline Treurnicht; Xie, Bin; McIntyre, Roger S
Cognitive enhancing agents are substances that may augment functions such as memory, attention, concentration, wakefulness, and intelligence. An anonymous, online survey containing a series of questions on the actual and hypothetical use of cognitive enhancers was sent via email to 647 medical students across all four years in one Canadian MD program. The response rate was 50% (326/647). Overall, 49 (15%, 95% CI: 11% to 19%) students admitted to non-medical and/or off-label use of one or more pharmaceutical stimulants, of whom 14 (4%, 95% CI: 2% to 6%) had used stimulants within the last year. Senior medical students reported recent use more often than junior students (8% vs. 2%, P = 0.04). Class seniority and male gender were both associated with positive attitudes towards use of these agents; favorable attitudes were associated with recent use of pharmaceutical stimulant and high-caffeine products. A substantial proportion of Canadian medical students have engaged at some point in non-medical and/or off-label use of stimulants for purposes of cognitive enhancement. Male students and those in upper years of the MD program were more likely to have used pharmaceutical stimulants in the last year, and have favorable attitudes concerning use of cognitive-enhancing agents.
Padegimas, E M; Clyde, C T; Zmistowski, B M; Restrepo, C; Williams, G R; Namdari, S
Currently, there is little information about the need for peri-operative blood transfusion in patients undergoing shoulder arthroplasty. The purpose of this study was to identify the rate of transfusion and its predisposing factors, and to establish a blood conservation strategy. We identified all patients who had undergone shoulder arthroplasty at our hospital between 1 January 2011 and 31 December 2013. The rate of transfusion was determined from the patient's records. While there were exceptions, patients typically underwent transfusion if they had a level of haemoglobin of transfusion. High- and low-risk cohorts for transfusion were identified from a receiver operating characteristic (ROC) curve. Of 1174 shoulder arthroplasties performed on 1081 patients, 53 cases (4.5%) required transfusion post-operatively. Predictors of blood transfusion were a lower pre-operative haematocrit (p transfusion. In total 48 of the 436 (11%) shoulder arthroplasties with a pre-operative haematocrit transfusion compared with five of the 738 (0.70%) shoulder arthroplasties with a haematocrit above this level. We found that transfusion was needed less frequently than previously described for shoulder arthroplasty. Patients with a pre-operative haematocrit blood transfusion, while those with a haematocrit above this level are unlikely to require transfusion. The rate of transfusion after shoulder arthroplasty is under 5%, and those with a pre-operative haematocrit greater than or equal to 39.6% have a very low likelihood (transfusion. ©2016 The British Editorial Society of Bone & Joint Surgery.
Bai, Xue Susan [University of Washington, Department of Radiology, Box 357115, Seattle, WA (United States); Petscavage-Thomas, Jonelle M. [Penn State Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Ha, Alice S. [University of Washington, Department of Radiology, Box 354755, Seattle, WA (United States)
Total elbow arthroplasty (TEA) is becoming a popular alternative to arthrodesis for patients with end-stage elbow arthrosis and comminuted distal humeral fractures. Prior outcome studies have primarily focused on surgical findings. Our purpose is to determine the radiographic outcome of TEA and to correlate with clinical symptoms such as pain. This is an IRB-approved retrospective review from 2005 to 2015 of all patients with semiconstrained TEA. All available elbow radiographs and clinical data were reviewed. Data analysis included descriptive statistics and Kaplan-Meier survival curves for radiographic and clinical survival. A total of 104 total elbow arthroplasties in 102 patients were reviewed; 75 % were in women and the mean patient age was 63.1 years. Mean radiographic follow-up was 826 days with average of four radiographs per patient. Seventy TEAs (67 %) developed radiographic complications, including heterotopic ossification (48 %), perihardware lucency (27 %), periprosthetic fracture (23 %), hardware subluxation/dislocation (7 %), polyethylene wear (3 %), and hardware fracture/dislodgement (3 %); 56 patients (55 %) developed symptoms of elbow pain or instability and 30 patients (30 %) underwent at least one reoperation. In patients with radiographic complications, 66 % developed elbow pain, compared to 19 % of patients with no radiologic complications (p = 0.001). Of the patients with radiographic complications, 39 % had at least one additional surgery compared to 0 % of patients without radiographic complications (p = 0.056). Radiographic complications are common in patients after total elbow arthroplasty. There is a strong positive association between post-operative radiographic findings and clinical outcome. Knowledge of common postoperative radiographic findings is important for the practicing radiologist. (orig.)
Full Text Available Introduction: Computer assisted surgery was pioneered in early 1990s. The first computer assisted surgery (CAS total knee replacement with an imageless system was carried out in 1997. In the past 25 years, CAS has progressed from experimental in vitro studies to established in vivo surgical procedures. Methods: A comprehensive body of evidence establishing the advantages of computer assisted surgery in knee and hip arthroplasty is available. Established benefits have been demonstrated including its role as an excellent research tool. Its advantages include dynamic pre-operative and per-operative assessment, increased accuracy in correction of deformities, kinematics and mechanical axis, a better alignment of components, better survival rates of prostheses and a better functional outcome. Adoption of computer navigation in the hip arthroplasty is still at an early stage compared to knee arthroplasty, though the results are well documented. Evidence suggests improved accuracy in acetabular orientation, positioning, hip offset and leg length correction. Results: Among the orthopaedic surgeons, navigated knee arthroplasty is gaining popularity though slowly. The uptake rates vary from country to country. The Australian joint registry data shows increased navigated knee arthroplasty from 2.4% in 2003 to 28.6% in 2015 and decreased revision rates with navigated knee arthroplasty in comparison with traditional instrumented knee arthroplasty in patient cohort under the age of 55 years. Conclusion: Any new technology has a learning curve and with practice the navigation assisted knee and hip arthroplasty becomes easy. We have actively followed the evidence of CAS in orthopaedics and have successfully adopted it in our routine practice over the last decades. Despite the cautious inertia of orthopaedic surgeons to embrace CAS more readily; we are certain that computer technology has a pivotal role in lower limb arthroplasty. It will evolve to become a
Deep, Kamal; Shankar, Shivakumar; Mahendra, Ashish
Computer assisted surgery was pioneered in early 1990s. The first computer assisted surgery (CAS) total knee replacement with an imageless system was carried out in 1997. In the past 25 years, CAS has progressed from experimental in vitro studies to established in vivo surgical procedures. A comprehensive body of evidence establishing the advantages of computer assisted surgery in knee and hip arthroplasty is available. Established benefits have been demonstrated including its role as an excellent research tool. Its advantages include dynamic pre-operative and per-operative assessment, increased accuracy in correction of deformities, kinematics and mechanical axis, a better alignment of components, better survival rates of prostheses and a better functional outcome. Adoption of computer navigation in the hip arthroplasty is still at an early stage compared to knee arthroplasty, though the results are well documented. Evidence suggests improved accuracy in acetabular orientation, positioning, hip offset and leg length correction. Among the orthopaedic surgeons, navigated knee arthroplasty is gaining popularity though slowly. The uptake rates vary from country to country. The Australian joint registry data shows increased navigated knee arthroplasty from 2.4% in 2003 to 28.6% in 2015 and decreased revision rates with navigated knee arthroplasty in comparison with traditional instrumented knee arthroplasty in patient cohort under the age of 55 years. Any new technology has a learning curve and with practice the navigation assisted knee and hip arthroplasty becomes easy. We have actively followed the evidence of CAS in orthopaedics and have successfully adopted it in our routine practice over the last decades. Despite the cautious inertia of orthopaedic surgeons to embrace CAS more readily; we are certain that computer technology has a pivotal role in lower limb arthroplasty. It will evolve to become a standard practice in the future in various forms like navigation
Cowling, Paul D; Holland, Philip; Kottam, Lucksy; Baker, Paul; Rangan, Amar
Background and purpose - Increasing numbers of shoulder arthroplasty are performed internationally. The predictors of intraoperative complications when implanting primary shoulder replacements are unknown. We determined the incidence of intraoperative complications during primary shoulder arthroplasty using the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man (NJR), and analyzed the associated risk factors for complications. Patients and methods - NJR data on primary shoulder arthroplasty were scrutinized for intraoperative complications. 2 analyses were performed: the first examined the incidence and predictors of any recorded complication; the second examined the incidence and predictors for intraoperative fractures specifically. Analysis of risk factors was performed using multivariable binary logistic regression modeling. Results - 12,559 primary shoulder arthroplasties were recorded, with an intraoperative complication rate of 2.5%, the majority being fractures (1.6% overall). The incidence of all complications was lower in men (RR vs. women =0.63 (95% CI 0.47-0.84)). Patients undergoing surgery for avascular necrosis (RR =2.3 (1.3-4.2)) or trauma sequelae (RR =1.6 (1.2-2.7)) had a higher risk of complications compared with OA. Patients undergoing a stemmed hemiarthroplasty (RR =1.8 (1.2-2.5)) and reverse shoulder arthroplasty (RR 1.6 (1.1-2.5)) had a higher risk of complications compared with total shoulder arthroplasty. The incidence of all complications was less in patients undergoing resurfacing arthroplasty (vs. total shoulder arthroplasty (RR 0.42 (0.24-0.73)) and when performing the superior approach (vs. deltopectoral (RR 0.56 (0.39-0.80)). Interpretation - This is the first study to use a national data set to examine risk factors for intraoperative complications during all types of primary shoulder arthroplasty, and identifies several previously unrecognized risk factors, such as surgical approach.
Full Text Available This article is about two patients having vascular injuries complicating total hip arthroplasty because of intraoperative indirect injuries. One patient had a delayed presentation of acute lower limb ischaemia, in which he required amputation of his left second toe because of ischaemic gangrene. The other patient had acute lower limb ischaemia leading to permanent muscle and nerve damage because of delayed recognition. Both patients had vascular interventions for the indirect vascular injuries. Preoperative workup for suspicious underlying peripheral vascular disease, intraoperative precautions, and perioperative period of vascular status monitoring are essential for prevention and early detection of such sinister events.
Codding, Jason L; Getz, Charles L
Pain control in total shoulder arthroplasty demands a multidisciplinary approach with collaboration between patients, surgeon, and anesthetist. A multimodal approach with preemptive medication, regional blockade, local anesthetics, and a combination of acetaminophen, nonsteroidal antiinflammatory drugs, tramadol, and gabapentinoids postoperatively leads to pain control and patient satisfaction. Assessment of patients' expectations constitutes a vital aspect of the preoperative patient evaluation. Educating and psychologically preparing patients reduces postoperative pain. Patients with anxiety and depression, preoperative narcotic use, and medical comorbidities are at an increased risk for suboptimal pain control. Minimizing narcotic use decreases opioid-related adverse effects and facilitates productive rehabilitation efforts. Copyright © 2017 Elsevier Inc. All rights reserved.
Margeson, J. [Industry Canada, Ottawa, ON (Canada)
The growth of the synthetic resin industry in Canada is described. In 1999 the industry had shipments totalling $6.3 billion and employed about 9,000 people in 105 establishments. The industry is concentrated in Alberta, Ontario and Quebec. Plants in Alberta produce commodity-grade thermoplastic resins from raw materials derived mainly from natural gas, whereas plants in Ontario and Quebec produce both thermoplastic and thermoset resins using raw materials derived from both crude oil and natural gas. Sixty-four per cent of the synthetic reins produced in Canada, worth about $4.1 billion, are exported. This is offset by imports of 68 per cent of domestic consumption, (valued at $5.0 billion) reflecting rationalization and specialization of the resin industry on a continental basis. Process and product technologies used in Canada are up-to-date and licensed from parent or other foreign chemical companies. Capital investment in the Canadian resin industry is lagging behind investment in the United States, however, this is expected to change once the impact of recent investments in the industry in Alberta is reflected in the statistics. A five to seven per cent real average annual growth in world-wide consumption is predicted over the next five years. Growth in North America is projected to be in the three to four per cent range. The Alberta-based component of the industry, being relatively new, is expected to improve its ability to compete globally in commodity thermoplastics. In contrast, the plants in Ontario and Quebec suffer from the fact that they were built prior to the Free Trade Agreement and were designed to satisfy domestic requirements. They are attempting to compensate for their lack of economics of scale by developing strategies to supply niche products. 8 figs.
Emmanuel Gomes Ciolac
Full Text Available OBJECTIVES: To analyze muscle strength and exercise intensity adaptation to resistance training in older women with knee osteoarthritis and total knee arthroplasty. METHODS: Twenty-three community-dwelling women were divided into the following groups: older, with knee osteoarthritis and total knee arthroplasty in the contralateral limb (OKG; N= 7; older, without symptomatic osteoarthritis (OG; N= 8; and young and healthy (YG; N= 8. Muscle strength (1-repetition maximum strength test and exercise intensity progression (workload increases of 5%-10% were made whenever adaptation occurred were compared before and after 13 weeks of a twice-weekly progressive resistance-training program. RESULTS: At baseline, OKG subjects displayed lower muscle strength than those in both the OG and YG. Among OKG subjects, baseline muscle strength was lower in the osteoarthritic leg than in the total arthroplasty leg. Muscle strength improved significantly during follow-up in all groups; however, greater increases were observed in the osteoarthritic leg than in the total knee arthroplasty leg in OKG subjects. Greater increases were also seen in the osteoarthritic leg of OKG than in OG and YG. The greater muscle strength increase in the osteoarthritic leg reduced the interleg difference in muscle strength in OKG subjects, and resulted in similar posttraining muscle strength between OKG and OG in two of the three exercises analyzed. Greater exercise intensity progression was also observed in OKG subjects than in both OG and YG subjects. CONCLUSIONS: OKG subjects displayed greater relative muscle strength increases (osteoarthritic leg than subjects in the YG, and greater relative exercise intensity progression than subjects in both OG and YG. These results suggest that resistance training is an effective method to counteract the lower-extremity strength deficits reported in older women with knee osteoarthritis and total knee arthroplasty.
Moukarzel, Marcel; Di Rienzo, Franck; Lahoud, Jean-Claude; Hoyek, Fadi; Collet, Christian; Guillot, Aymeric; Hoyek, Nady
The aim of this study was to measure physical and functional outcomes during the acute postoperative recovery in patients who underwent total knee arthroplasty. Motor imagery has been shown to decrease pain and promote functional recovery after both neurological and peripheral injuries. Yet, whether motor imagery can be included as an adjunct effective method into physical therapy programs following total knee arthroplasty remains a working hypothesis that we aim to test in a pilot study. Twenty volunteers were randomly assigned to either a motor imagery or a control group. Pain, range of motion, knee girth as well as quadriceps strength and Timed Up and Go Test time were the dependent variables during pre-test and post-test. The motor imagery group exhibited larger decrease of ipsilateral pain and knee girth, a slightly different evolution of range of motion and an increase of ipsilateral quadriceps strength compared to the control group. No effects of motor imagery on Timed Up and Go Test scores were observed. Implementing motor imagery practice into the course of physical therapy enhanced various physical outcomes during acute postoperative recovery after total knee arthroplasty. According to this pilot study, motor imagery might be relevant to promote motor relearning and recovery after total knee arthroplasty.Partial effect-sizes should be conducted in the future. Implications for rehabilitation Adding motor imagery to physical therapy sessions during the acute period following total knee arthroplasty: • Enhances quadriceps strength. • Alleviates pain. • Enhances range of motion. • Does not have any effect on basic functional mobility. • Does not have any effect on knee girth.
Voorde, Pia C Ten; Rasmussen, Jeppe V; Olsen, Bo S
with adjustment for age, sex, and previous surgery. RESULTS: During the study period, 167 patients underwent shoulder arthroplasty because of rheumatoid arthritis, 80 (48%) of whom received RHA and 34 (26%) of whom received SHA. 16 patients were treated with total stemmed shoulder arthroplasty (TSA), and 24 were...... treated with reverse shoulder arthroplasty (rTSA). 130 patients returned a completed questionnaire, and the total mean WOOS score was 63. The cumulative 5-year revision rate was 7%. Most revisions occurred after RHA, with a revision rate of 14%. Mean WOOS score was similar for RHA and for SHA...
Ioannidis, George; Papaioannou, Alexandra; Thabane, Lehana; Gafni, Amiram; Hodsman, Anthony; Kvern, Brent; Johnstone, Dan; Plumley, Nathalie; Baldwin, Alanna; Doupe, M.; Katz, Alan; Salach, Lena; Adachi, Jonathan D.
PROBLEM ADDRESSED Family physicians are not adequately following the 2002 Osteoporosis Canada guidelines for providing optimal care to patients with osteoporosis. OBJECTIVE OF PROGRAM The Canadian Quality Circle (CQC) pilot project was developed to assess the feasibility of the CQC project design and to gather informationfor implementing a national study of quality circles (QCs). The national study would assess whether use ofQCs could improve family physicians’ adherence to the osteoporosis guidelines. PROGRAM DESCRIPTION The pilot project enrolled 52 family physicians and involved 7 QCs. The project had 3 phases: training and baseline data collection, educational intervention and follow-up data collection, and sessions on implementing strategies for care. CONCLUSION Findings from the pilot study showed that the CQC project was well designed and well received. Use of QCs appeared to be feasible for transferring knowledge and giving physicians an opportunity to analyze work-related problems and develop solutions to them. PMID:17934033
Application of Terrestrial Ecosystem Monitoring under the CAFF Circumpolar Biodiversity Monitoring Program: Designing and Implementing Terrestrial Monitoring to Establish the Canadian High Arctic Research Station as a Flagship Arctic Environmental Monitoring Site
McLennan, D.; Kehler, D.
The Canadian High Arctic Research Station (CHARS) is scheduled for completion in July 2017 and is the northern science component of Polar Knowledge Canada (POLAR). A mandated goal for POLAR is to establish the adjacent Experimental and Reference Area (ERA) as an Arctic Flagship monitoring site that will track change in Arctic terrestrial, freshwater and marine ecosystems. Situated in the community of Cambridge Bay, CHARS provides the opportunity to draw on the Indigenous Knowledge of local residents to help design and conduct the monitoring, and to operate 12 months a year. Monitoring at CHARS will be linked to networks nationally and internationally, and is being designed so that change in key indicators can be understood in terms of drivers and processes, modeled and scaled up regionally, and used to predict important changes in critical indicators. As a partner in the Circumpolar Biodiversity Monitoring Program (CBMP), the monitoring design for terrestrial ecosystems follows approaches outlined by the CBMP Terrestrial Expert Monitoring Group, who have listed key monitoring questions and identified a list of important Focal Ecosystem Components (FECs). To link drivers to FECs we are proposing a multi-scaled approach: 1) an Intensive Monitoring Area to establish replicated monitoring plots that track change in snow depth and condition, active layer depth, soil temperature, soil moisture, and soil solution chemistry that are spatially and temporally linked to changes in microbiological activity, CO2/CH4 net ecosystem flux, vegetation relative frequency, species composition, growth and foliar nutrient concentration, arthropod abundance, lemming abundance and health, and shorebird/songbird abundance and productivity. 2) These intensive observations are supported by watershed scale measures that will monitor, during the growing season, lemming winter nest abundance, songbird, shorebird and waterfowl staging and nesting, and other observations; in the winter we will
The Canadian Association of Petroleum Producers (CAPP) represents oil and gas companies throughout Canada; its members produce over 90% of Canada's natural gas and crude oil output. The aim of the Association is to improve the economics of the Canadian upstream petroleum sector in an environmentally and socially responsible way. The aim of this Responsible Canadian Energy report is to present the performance data of CAPP's members for the year 2009. Data, trends, and performance analyses are provided throughout the document. This analysis makes it possible to determine where progress has been made and where performance improvement is necessary. It also presents success stories and best practices so that other companies can learn from them how to improve their own performance. This paper provides useful information on the performance of the upstream petroleum industry in Canada and highlights where the focus should be for further improvement in its performance.
Jones, Richard E
Obtaining primary wound healing in total joint arthroplasty is essential to a good result. Wound healing problems can occur and the consequences can be devastating. Determination of the host healing capacity can be useful in predicting complications. Cierney and Mader classified patients as type A, no healing compromises; and type B, systemic or local healing compromising factors present. Local factors include traumatic arthritis, multiple previous incisions, extensive scarring, lymphedema, poor vascular perfusion. Systemic compromising factors include diabetes, rheumatic diseases, renal or liver disease, immunocompromise, steroids, smoking, and poor nutrition. In high-risk patients, the surgeon should encourage positive choices such as smoking cessation and nutritional supplementation to elevate the total lymphocyte count and total albumin. Careful planning of incisions, particularly in patients with scarring or multiple previous operations, is productive. Around the knee the vascular viability is better in the medial flap. Thus, use the most lateral previous incision, do minimal undermining, and handle tissue meticulously. We perform all potentially complicated total knee arthroplasties without tourniquet to enhance blood flow and tissue viability. The use of perioperative anticoagulation will increase wound problems. If wound drainage or healing problems occur, immediate action is required. Deep sepsis can be ruled out with a joint aspiration and cell count (>2000), differential (>50% polys), and negative culture and sensitivity. All hematomas should be evacuated and necrosis or dehiscence should be managed by debridement to obtain a live wound. Copyright 2010, SLACK Incorporated.
Tarasevicius, Sarūnas; Zegunis, Vidmantas; Tarasevicius, Rimantas; Kalesinskas, Romas Jonas; Janusonis, Vinsas
To evaluate the risk factors after total hip replacement arthroplasty for rerevision and to analyze complications after hip revision surgery. We obtained data from 117 hip revisions and 12 hip rerevision arthroplasties performed in 1992-2001 in the Department of Orthopedics of Klaipeda Hospital. Special forms were filled in for every patient who participated in the study. Name, operation date, type of implants, operative technique, revision diagnosis, intraoperative and postoperative complications were recorded. All patients were checked for death until 2003. Hip revisions were performed for 77 (66%) women and 50 (44%) men in 1992-2001. We revised 22 (19%) cups, 6 (5%) stems, 86 (74%) total hip revisions; femoral head was exchanged for 3 patients. Revision diagnoses were: aseptic loosening in 106 (90%) cases, recurrent dislocations in 7 (6%) cases, and periprosthetic fractures in 4 (4%) cases. Patients' age varied from 26-82 years, average 63.5 years. In revision group only 8% of patients were less than 50 years old, compared to 33% in rerevision group. Morselized allografts and bone impaction technique for reconstruction of bone defects were used in 70 (60%) of cases. We rerevised one cup only for which revision morselized allografts were used. Eight (67%) rerevisions were performed after first 28 (24%) hip revisions. Patients, who underwent revision surgery being younger than 50 years old, were at higher risk for rerevision surgery. Revision with morselized bone allografts and bone impaction technique decreases number of rerevisions. Learning curve was steep and had great influence to our results.
Full Text Available This paper is a brief overview of the concept of the transnational archive as a counterpoint to the idea that a national archive is necessarily a locus of a static idea of nation. The Canadian national archives is used as a case study of an archives that was transnational in its inception, and one that has continued to change in its mandate and materials as a response to patterns in migration and changing notions of multiculturalism as a Canadian federal policy. It introduces the most recent formation of the transnational archive and its denizens: the genealogical archive inhabited by family historians.
Maslow, Jed; Zuckerman, Joseph D; Immerman, Igor
Post-patellectomy patients represent a specific subgroup of patients that may develop arthritis and persistent knee pain and potentially require treatment with total knee arthroplasty. This article reviews the treatment and functional outcomes following total knee arthroplasty in patients with prior patellectomy. A case report is presented as an example of the clinical management of a post-patellectomy patient with significant knee pain and disability treated with total knee arthroplasty. Emphasis will be placed in decision- making, specifically with the use of a posterior stabilized implant. In addition, postoperative strengthening of the quadriceps is essential to compensate for the lack of the patella and increase the success of total knee arthroplasty in this subgroup of patients.
Full Text Available BACKGROUND: Knee pain is one of the major sources of pain and disability in developed countries, particularly in aging populations, and is the primary indication for total knee arthroplasty (TKA in patients with osteoarthritis (OA.
Schoch, Bradley; Werthel, Jean-David; Sperling, John W; Cofield, Robert H; Sanchez-Sotelo, Joaquin
Charcot arthropathy is a rare cause of debilitating joint destruction. Shoulder arthroplasty for Charcot arthropathy is challenging secondary to local bone and soft tissue loss, lack of protective sensation, and altered muscle control...
Gutiérrez, Sergio; Keller, Tony S; Levy, Jonathan C; Lee, William E; Luo, Zong-Ping
Reverse shoulder arthroplasty is being used more frequently to treat irreparable rotator cuff tears in the presence of glenohumeral arthritis and instability. To date, however, design features and functions of reverse shoulder arthroplasty, which may be associated with subluxation and dislocation of these implants, have been poorly understood. We asked: (1) what is the hierarchy of importance of joint compressive force, prosthetic socket depth, and glenosphere size in relation to stability, and (2) is this hierarchy defined by underlying and theoretically predictable joint contact characteristics? We examined the intrinsic stability in terms of the force required to dislocate the humerosocket from the glenosphere of eight commercially available reverse shoulder arthroplasty devices. The hierarchy of factors was led by compressive force followed by socket depth; glenosphere size played a much lesser role in stability of the reverse shoulder arthroplasty device. Similar results were predicted by a mathematical model, suggesting the stability was determined primarily by compressive forces generated by muscles.
C.J. de Ruiter; Dr. D.M. van Leeuwen; P.A. Nolte; A. de Haan
Objective. To investigate the feasibility and effects of additional preoperative high intensity strength training for patients awaiting total knee arthroplasty (TKA). Design. Clinical controlled trial. Patients. Twenty-two patients awaiting TKA. Methods. Patients were allocated to a standard
Clayton, M L; Leidholt, J D; Clark, W
Deformity of the forefoot is a common disabling problem in chronic rheumatoid arthritis. The most common deformifies are hallux valgus, cockup toes, and depressed metatarsal heads. Resection arthroplasty has been improved by adding reconstructive procedures, for example, medial capsular arthroplasty in the great toe and plantar plate arthroplasty of the lesser toes with longitudinal pinning of all toes for 4 weeks. Results were compared with a series of silicone double hinge implants without grommets in the great toe and resection of lesser metatarsal heads and pinning. Patients were evaluated by questionnaire to evaluate outcome. There was no significant difference in the two series of patients. Overall good results were 85% to 95% and slightly favored the group without implants. These results were equal to those reported in the literature for patients who underwent fusion of the great toe and resection arthroplasty of lesser toes.
Koeter, S.; Jackson, R.W.
Articular sporotrichosis, a chronic granulomatous fungal infection, is a rare entity but when present may lead to significant joint destruction. Severe knee arthrosis due to sporotrichal arthritis has traditionally been treated with arthrodesis. Total knee arthroplasty in the presence of
Narici, Marco; Conte, M; Salvioli, Stefano
This study investigated features of skeletal muscle ageing in elderly individuals having previously undergone unilateral total knee arthroplasty (TKA) and whether markers of sarcopenia could be mitigated by a 12-week alpine skiing intervention. Novel biomarkers agrin, indicative of neuromuscular...
Bainbridge, Joyce; Carbonaro, Mike; Green, Nicole
This article presents the findings of an online survey administered to Alberta elementary school teachers in 2000-2001. The survey explored the teachers' knowledge and use of Canadian children's literature and their thoughts about the role of Canadian literature in elementary school classrooms. Canadian children's trade books espouse particular…
Cancienne, Jourdan M; Brockmeier, Stephen F; Gulotta, Lawrence V; Dines, David M; Werner, Brian C
There have been few studies that have evaluated ambulatory total shoulder arthroplasty. The objectives of the present study were to investigate the current trends in ambulatory total shoulder arthroplasty in the United States; to characterize the rate of postoperative complications, hospital readmission, and risk factors associated with readmission; and to conduct a cost analysis comparing ambulatory total shoulder arthroplasty with matched inpatient total shoulder arthroplasty. A national insurance database was queried for patients who underwent anatomic total shoulder arthroplasty between the fourth quarter of 2010 and 2014. Patients undergoing ambulatory total shoulder arthroplasty and a matched group of patients undergoing inpatient total shoulder arthroplasty were identified. Complications were assessed for both groups. Risk factors for readmission within 90 days postoperatively were examined. The costs up to 30 days postoperatively were evaluated for patients who underwent ambulatory total shoulder arthroplasty and controls. Included in the study were 706 patients who underwent ambulatory total shoulder arthroplasty. From the fourth quarter of 2010 to 2014, the yearly incidence of ambulatory total shoulder arthroplasty doubled. In the study, 4,459 patients who underwent inpatient total shoulder arthroplasty were matched to patients who underwent ambulatory total shoulder arthroplasty. In no instances were any complications present at a significantly higher rate in the patients who underwent ambulatory total shoulder arthroplasty. The rate of readmission was not significantly different (p > 0.05) between the 2 cohorts. The patients undergoing ambulatory total shoulder arthroplasty had significantly lower costs (p ambulatory total shoulder arthroplasty is a viable and safe practice model. Ambulatory total shoulder arthroplasty also offers significant cost savings compared with inpatient total shoulder arthroplasty in matched patients. Therapeutic Level III. See
Triplet, Jacob J; Everding, Nathan G; Levy, Jonathan C; Moor, Molly A
Recovery of functional internal rotation after primary shoulder arthroplasty is essential to perform many important activities of daily living. Functional internal rotation is typically reported as it relates to clinical examination findings of motion (posterior reach) and lift-off or belly-press tests. A more detailed evaluation of functional recovery of internal rotation after primary anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) is needed. A retrospective review of patients treated with primary TSA (n = 132) and RSA (n = 91) with a minimum 2-year follow-up was performed. Subanalysis of revision RSA (n = 24) and primary RSA was performed. Active range of motion, subjective internal rotation motion, manual internal rotation strength, and specific questions related to internal rotation function isolated from the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) functional questionnaires were reviewed. Compared with RSA, TSA patients could more likely reach the small of the back (SST) and wash the back/fasten bra (ASES). Active internal rotation motion, SST score, ASES score, and subjective internal rotation were greater after TSA. No significant difference was observed with respect to managing toileting between cohorts. Revision RSA patients were less likely to be able to wash the back/fasten bra (ASES) and easily manage toileting (ASES) compared with primary RSA patients. Primary anatomic shoulder arthroplasty yields greater functional internal rotation than does primary RSA, with either procedure being effective at managing toileting. Patient education regarding activities of daily living related to internal rotation can be predicted. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
Richards, R.; Tripp, J.; Mukherji, R.; Ghafoor, N.; Sallaberger, C.
In coming decades planetary exploration will change its focus from remote observation to robotic in situ exploration sample-return missions and eventually human missions Two Canadian companies have combined 30 years of heritage in terrestrial and space technologies to provide new capabilities in space including autonomous landing and exploration technologies for lunar exploration MDA is the world leader in space robotics a key element of the Canadian Space Program for the last two decades with over 2-billion CDN of total investment Robotic arms designed and built by MDA are used on virtually all flights of the Space Shuttle and the three robotic systems comprising the Mobile Servicing System - SSRMS MBS and SPDM - have been designed and built for the International Space Station Optech is the world leader in terrestrial lidar systems with 30 years of technology heritage A strategic partnership of MDA and Optech was formed in 2002 to provide unique space lidar solutions for space operations and planetary exploration Now as robotic exploration moves in earnest beyond Earth orbit strategic technologies are being developed by Optech and MDA that will allow Canada to expand its world leading position in space sensors and robotics to become a dominant provider of robotic exploration systems and missions targeted at the Moon Mars asteroids and beyond The key requirements for successful planetary exploration in topographically diverse areas include a spacecraft capable of precision landing and hazard avoidance Since 2001 Optech and MDA
DNA barcoding has proven an effective tool for species identification in varied groups of marine invertebrates including crustaceans, molluscs, polychaetes and echinoderms. In this study, we further validate its utility by analyzing almost half of the 300 species of Echinodermata known from Canadian waters. COI sequences from 999 specimens were assigned to 145 BINs. In most cases, species discrimination was straightforward due to the large difference (25-fold) between mean intra- (0.48%) and inter- (12.0%) specific divergence. Six species were flagged for further taxonomic investigation because specimens assigned to them fell into two or three discrete sequence clusters. The potential influence of larval dispersal capacity and glacial events on patterns of genetic diversity is discussed for 19 trans-oceanic species. Although additional research is needed to clarify biogeographic patterns and resolve taxonomic questions, this study represents an important step in the assembly of a DNA barcode library for all Canadian echinoderms, a valuable resource for future biosurveillance programs. PMID:27870868
Kara K S Layton
Full Text Available DNA barcoding has proven an effective tool for species identification in varied groups of marine invertebrates including crustaceans, molluscs, polychaetes and echinoderms. In this study, we further validate its utility by analyzing almost half of the 300 species of Echinodermata known from Canadian waters. COI sequences from 999 specimens were assigned to 145 BINs. In most cases, species discrimination was straightforward due to the large difference (25-fold between mean intra- (0.48% and inter- (12.0% specific divergence. Six species were flagged for further taxonomic investigation because specimens assigned to them fell into two or three discrete sequence clusters. The potential influence of larval dispersal capacity and glacial events on patterns of genetic diversity is discussed for 19 trans-oceanic species. Although additional research is needed to clarify biogeographic patterns and resolve taxonomic questions, this study represents an important step in the assembly of a DNA barcode library for all Canadian echinoderms, a valuable resource for future biosurveillance programs.
The Canadian Petroleum Products Institute (CPPI) is an association of Canadian companies involved in the downstream sector of the petroleum industry which includes refining, distributing and marketing of petroleum products. CPPI`s mandate includes: (1) establishing environmental policies, (2) establishing working relationships with governments to develop public policy, (3) developing guidelines for the safe handling of petroleum products, and (4) providing information about the petroleum industry to the public. Canada`s 19 refineries processed an average of 1.5 million barrels of crude oil per day in 1996. Domestic sources of crude made up 61 per cent of crude oil processed in 1996. Total exports during the year amounted to 105 million barrels. Some of the issues that the CPPI focused on during 1996 included the controversy over the future of the octane enhancing fuel additive MMT, fuel quality standards for transportation fuels and reformulated fuels, gasoline pricing, air quality and workplace safety. CPPI members` participation in the Voluntary Challenge and Registry (VCR) program towards reducing greenhouse gas emissions was also discussed. The industry was also actively involved in seeking to improve its refinery wastewater discharges.
Schoch, Bradley S; Aibinder, William R; Werthel, Jean-David; Sperling, John W; Sanchez-Sotelo, Joaquin; Cofield, Robert H
Previous reports have shown an increased risk of complications after arthroplasty in the obese population. It remains unclear if gastric bypass surgery prior to shoulder arthroplasty modifies the complication and failure rate. The purpose of this study is to assess the complication and re-operation rates following shoulder arthroplasty in this population. Between 2002 and 2012, 39 shoulders with prior gastric bypass underwent shoulder arthroplasty (3 HA, 16 TSA, 20 RSA). The mean time from the gastric bypass to arthroplasty was 13 years (range, 0.7-32). Shoulders were followed for a minimum of two years (mean, 3.8 years) or until re-operation. Outcome measures included pain, range of motion, satisfaction, modified Neer ratings, and ASES scores. Complications occurred in seven shoulders (18%), with five requiring re-operation. There was no common failure mechanism. Re-operations occurred for aseptic glenoid loosening, periprosthetic fracture, and unexplained pain. Those shoulders with complications were similar to those without in regard to age, sex, and BMI. Complications were more common following anatomic arthroplasty compared to reverse arthroplasty (5 vs 1, p = 0.06); however, complications were not improved compared to historical controls with morbid obesity. Overall, pain improved significantly from 4.8 pre-operatively to 2.3 postoperatively (p bypass surgery prior to shoulder arthroplasty leads to clinical improvement in both pain and range of motion. Prior gastric bypass surgery does not result in a lower surgical complication rate compared to previously published reports in the morbidly obese population. Level 4, case series.
Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B
With the implementation of fast-track surgery with optimization of both logistical and clinical features, the postoperative convalescence has been reduced as functional milestones have been achieved earlier and consequently length of stay (LOS) in hospital has been reduced. However, it has been s...... speculated that a decrease in LOS may be associated with an increase in readmissions in general, including risk of dislocation after total hip arthroplasty (THA) or manipulation after total knee arthroplasty (TKA)....
Full Text Available AIM: Citation analyses are often used as a measurement of an article’s impact in a specific field of study. Clinically, shoulder arthroplasty has been a rapidly growing field, and there has been ample research done on it in the past few decades. The purpose of this study is to determine the 50 most cited articles in shoulder arthroplasty and their characteristics. METHODS: The Science Citation Index Expanded was searched for citations of articles related to shoulder arthroplasty (including total shoulder, reverse shoulder arthroplasty, and hemiarthroplasty published in the 72 journals in the category “Orthopedics”. The 50 most cited articles were determined and the following characteristics were analyzed in each article: authors, journal, year of publication, country of origin, number of citations, citation density (total number of citations/years since publication, article type (clinical or basic science, article subtype via study design and level of evidence. RESULTS: The number of citations ranged from 594 to 104, with citation density ranging from 28.8 to 4.1. The 50 most cited articles in shoulder arthroplasty were published in 6 of the 72 journals, most from 1970s to 2010s and represented by 10 countries. The articles were composed of 7 study designs with the most common being case series and 7 topics within shoulder arthroplasty. The most common level of evidence was IV (35 out of 50 studies. CONCLUSION: Articles with the highest citation density were those discussing reverse shoulder arthroplasty. The top 50 list provides residents, fellows and researchers with a comprehensive list of the major academic contributions to shoulder arthroplasty.
Allepuz, A; Serra-Sutton, V; Martínez, O; Tebé, C; Nardi, J; Portabella, F; Espallargues, M
The aim is to present the functioning and results of the Catalan Arthroplasty Registry (RACat). The RACat arose by the initiative of the Catalan Society of Orthopaedic Surgery and Traumatology, the Catalan Health Service (CHS) and the Catalan Agency for Health Information Assessment and Quality. Publicly funded hospitals sent information through the Internet (CHS Applications website) on knee and hip arthroplasties: patient identification, hospital, joint (hip/knee), type (primary/revision), side of operation, date of surgery and prosthesis (manufacturer's name and reference number). The quality of the data is analysed regularly. We estimate the risk of replacement by the Kaplan-Meier method. A total of 52 hospitals out of 62 send data to RACat, and information on 36,951 knee and 26,477 hip arthroplasties is available. Data quality improved between 2005 and 2010. In 2010 coverage exceeded 70%, with side of operation 97%, and prostheses identification of 80%. The risk of replacement at three years was 3.3% (95% CI:3.1-3.6) for knee, 2.9% (95% CI:2.5-3.3) for total hip, and 2.5% (95% CI:2.0-3.1) for partial hip. Risk of replacement is higher than that observed in other registers, although data quality and its improvement over time should be taken into account. The information available in the RACat will help to establish a standard that will enable hospitals to compare results. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.
Social Justice or Status Quo? Blended Learning in a Western Canadian Teacher Education Program | Justice sociale ou statu quo ? L’apprentissage mixte dans un programme de formation d’enseignants dans l’Ouest canadien
Full Text Available Sustainable pre-service teacher education is needed to encourage academic success for under-represented populations, through both culturally responsive and alternative programming options (Carr-Stewart, Balzer, & Cottrell, 2013. In 2013, the Western Canadian University that served as the basis for this case study, implemented a blended learning pilot course in multicultural education for its existing cohort of pre-service teachers, within their Indigenous Focus Teacher Education Program (IFTEP. The aim of the blended pilot was to increase flexibility in participation for the IFTEP students, who were all employed full time as teacher assistants within a local school board. The author examined the design model through qualitative analysis of student interview data, contrasted against observations of activities on the learning management system (LMS. Five themes emerged as important in effective and culturally responsive practice for blended learning design, in this case related to: institutional challenges, student autonomy and the complexity of commitments. This research presents a critical review of the feasibility of adopting blended learning for Indigenous students. Afin de favoriser la réussite scolaire des populations sous-représentées, il est nécessaire que la formation initiale des enseignants soit durable, et ce, par l’entremise d’options de programmes à la fois culturellement sensibles et alternatives (Carr-Stewart, Balzer et Cottrell, 2013. En 2013, l’université de l’Ouest canadien qui a servi de base pour la présente étude de cas a mis en œuvre un cours pilote en apprentissage mixte portant sur l’éducation multiculturelle pour la cohorte existante d’enseignants en formation initiale au sein de son programme de formation des enseignants axé sur les Premières Nations (IFTEP. Ce pilote mixte avait pour objectif d’augmenter la flexibilité de la participation des étudiants de l’IFTEP, qui étaient tous employ
de Wolf, Gaelan Dodds
A study compared salient variables of Canadian English from two concurrent sociodialectal surveys, one for Ottawa, Ontario and one for Vancouver, British Columbia. Using the Labovian model of phonological variation in association with sociological parameters and other linguistic variables within each specific area, the analysis investigated four…
Spitzer, Denise L
.... Focusing on the context of Canadian policy and society, the contributors illuminate migrants' testimonies of struggle, resistance, and solidarity as they negotiate a place for themselves in a new country. Topics range from the difficulties of Francophone refugees and the changing roles of fathers, to the experiences of queer newcomers and the importance of social unity to communal and individual health."--pub. desc.
Brcic, Jelena; Della-Rossa, Irina
Values are desirable, trans-situational goals, varying in importance, that guide behavior. Research has demonstrated that universal values may alter in importance as a result of major life events. The present study examines the effect of spaceflight and the demands of astronauts' job position as life circumstances that affect value priorities. We employed thematic content analysis for references to Schwartz's well-established value markers in narratives (media interviews, journals, and pre-flight interviews) of seven Canadian astronauts and compared the results to the values of National Aeronautics and Space Administration (NASA) and Russian Space Agency (RKA) astronauts. Space flight did alter the level of importance of Canadian astronauts' values. We found a U-shaped pattern for the values of Achievement and Tradition before, during, and after flight, and a linear decrease in the value of Stimulation. The most frequently mentioned values were Achievement, Universalism, Security, and Self-Direction. Achievement and Self Direction are also within the top 4 values of all other astronauts; however, Universalism was significantly higher among the Canadian astronauts. Within the value hierarchy of Canadian astronauts, Security was the third most frequently mentioned value, while it is in seventh place for all other astronauts. Interestingly, the most often mentioned value marker (sub-category) in this category was Patriotism. The findings have important implications in understanding multi-national crew relations during training, flight, and reintegration into society.
take on challenges such as these. In 2009, eight stellar scientists from developing countries were chosen to collaborate with a Canada Research Chair on a five-year program of research and training. Another major initiative, the Develop- ment Innovation Fund, is set to unleash the creativity and enterprise of top scien-.
Aug 7, 2013 ... IDRC is one of the world's leaders in generang new knowledge to meet global challenges. We offer a number of research awards providing a unique opportunity to enhance research skills and gain a fresh perspecve on crucial development issues. These one‐year, paid, in‐house programs of training and ...
Karampinas, Panagiotis K; Papadelis, Eustratios G; Vlamis, John A; Basiliadis, Hlias; Pneumaticos, Spiros G
Young patients feel that maintaining sport activities after total hip arthroplasty constitutes an important part of their quality of life. The majority of hip surgeons allow patients to return to low-impact activities, but significant caution is advised to taking part in high-impact activities. The purpose of this study is to compare and evaluate the post-operative return to daily living habits and sport activities following short-metaphyseal hip and high functional total hip arthroplasties (resurfacing and big femoral head arthroplasties). In a study design, 48 patients (55 hips) were enrolled in three different comparative groups, one with the short-metaphyseal arthroplasties, a second with high functional resurfacing arthroplasties and a third of big femoral head arthroplasties. Each patient experienced a clinical examination and evaluated with Harris Hip Score, WOMAC, Sf-36, UCLA activity score, satisfaction VAS, anteroposterior and lateral X-rays of the hip and were followed in an outpatient setting for 2 years. Statistical analysis revealed no notable differences between the three groups regarding their demographic data however significant differences have been found between preoperative and postoperative clinical scores of each group. Also, we fail to reveal any significant differences when comparing data of all three groups at the final 2 years postoperative control regarding their clinical scores. The overall outcome of all three groups was similar, all the patients were satisfied and returned to previous level of sport activities. Short metaphyseal hip arthroplasties in young patients intending to return to previous and even high impact sport activities, similar to high functional resurfacing, big femoral head arthroplasties. Short stems with hard on hard bearing surfaces might become an alternative to standard stems and hip resurfacing.
Guo Rong She
Conclusion: We herein report a case of pyoderma gangrenosum patient underwent total hip arthroplasty, meanwhile raise the issue of management in perioperative period for pyoderma gangrenosum patient, especially explore series of standardized therapies for this disease during arthroplasty.
arthroplasties. The results were compared to that of general population in Finland. The mean duration of follow-up for MOM arthroplasty was 15.7 years; for polyethylene arthroplasty, it was 12.5 years. The standardized incidence ratio for all cancers in the MOM group was 0.95 (95% CI, 0.79-1.13). In the polyethylene on metal group it was 0.76 (95% CI, 0.68-0.86). The combined standardized incidence ratio for lymphoma and leukemia in the patients who had MOM THR was 1.59 (95% CI, 0.82-2.77). It was 0.59 (95% CI, 0.29-1.05) for the patients who had polyethylene on metal THR. Patients with MOM THR had a significantly higher risk of leukemia. All patients who had leukemia were aged over than 60 years. EPIDEMIOLOGICAL STUDIES OF MYOCARDIOPATHY OF BEER DRINKERS: An unusual type of myocardiopathy, characterized by pericardial effusion, elevated hemoglobin concentrations, and congestive heart failure, occurred as an epidemic affecting 48 habitual beer drinkers in Quebec City between 1965 and 1966. This epidemic was directly related the consumption of a popular beer containing cobalt sulfate. The epidemic appeared 1 month after cobalt sulfate was added to the specific brewery, and no further cases were seen a month after this specific chemical was no longer used in making this beer. A beer of the same name is made in Montreal, and the only difference at that time was that the Quebec brand of beer contained about 10 times more cobalt sulphate. Cobalt has been added to some Canadian beers since 1965 to improve the stability of the foam but it has been added in larger breweries only to draught beer. However, in small breweries, such as those in Quebec City, separate batches were not brewed for bottle and draught beer; therefore, cobalt was added to all of the beer processed in this brewery. In March 1966, a committee was appointed under the chairmanship of the Deputy Minister of Health for Quebec that included members of the department of forensic medicine of Quebec's Ministry of Justice
Akhavan, Sina; Nguyen, Long-Co; Chan, Vanessa; Saleh, Jamal; Bozic, Kevin J
Perioperative smoking has been linked to surgical complications including poor wound healing, infection, myocardial infarction, prolonged length of stay, need for mechanical ventilation, and death. This study evaluated the effectiveness of preoperative counseling on smoking cessation for patients undergoing elective total joint arthroplasty. Thirty smokers with hip or knee osteoarthritis seeking hip or knee replacement surgery were enrolled prospectively. Interventions included counseling, referrals to smoking cessation programs including the California Smokers' Helpline and the Fontana Tobacco Treatment Program, nicotine replacement therapy (NRT), or instructing patients quit through the "cold turkey" method of abstinence. Patients were scheduled for surgery if they demonstrated abstinence from smoking, confirmed via expired carbon monoxide (CO) breath testing. Short- and long-term smoking cessation rates were evaluated. Thirty patients were enrolled; 21 patients (70%) passed the CO test, whereas 9 patients (30%) failed or did not follow up with a CO test. Thirteen of 21 patients (62%) quit using the "cold turkey" method, 5 of 21 patients (24%) quit using NRT, and 3 of 21 patients (14%) quit using outpatient treatment programs. Eighteen of 21 patients (86%) who quit smoking underwent surgery, and 14 patients had surgery within 6 months of smoking abstinence. Nine of the 14 patients (64%) remained smoke-free 6 months postoperatively confirmed through telephone questionnaire. These results suggest that elective surgery offers a strong incentive for patients to quit smoking, and surgeons can play a role offering a teachable moment and motivating this potentially life-altering behavioral change. [Orthopedics. 2017; 40(2):e323-e328.]. Copyright 2016, SLACK Incorporated.
Full Text Available Multicentric disappearing bone disease, or Gorham disease, is a rare entity. A middle age woman, presented to us with left sided antalgic gait and severe bony deformity of her left knee. Radiograph revealed massive bone defect of the medial condyle of the left tibia with subluxation of the knee joint. She was scheduled for knee replacement in six months. However, she developed another lesion over the right hip that typically mimicked the disease progression of disappearing bone disease. The right femoral head vanished progressively within three months without significant history of infection or trauma. Subsequent bone biopsy of the right femoral head and left tibia condyle confirmed the diagnosis. Total knee replacement was carried out for her left knee. She remained pain free on her left knee. A year later, after confirming by sequential radiographs that the osteolysis had stopped, total right hip replacement was performed. Five years later, she remained pain free and both the arthroplasties were stable.
Plaschke, Hans Christian; Thillemann, Theis M; Brorson, Stig
BACKGROUND: Total elbow arthroplasty (TEA) is an established treatment for late-stage arthritis of the elbow. Indications have expanded to osteoarthritis and nonunion in distal humeral fractures. Information on implant survival and risk factors for revision is still sparse. The aim of this study...... was to evaluate implant survival and risk factors for revision of TEAs inserted in patients in the eastern part of Denmark in the period from 1980 until 2008. MATERIAL AND METHODS: The Danish National Patient Register provided personal identification numbers for patients who underwent TEA procedures from 1980...... until 2008. On the basis of a review of medical reports and linkage to the National Patient Register, we calculated revision rates and evaluated potential risk factors for revision, including, age, sex, period, indication for TEA, and implant design. RESULTS: We evaluated 324 primary TEA procedures...
Boeckstyns, Michel E. H.; Herzberg, G.; Merser, Søren
Background and purpose During the past 40 years, several attempts have been made with total wrist arthroplasty to avoid fusion in severely destroyed wrists. The results have often been disappointing. There is only modest clinical documentation due to the small number of patients (especially non......-rheumatoid cases) and short follow-up times. Here we report a multicenter series using a third-generation implant with a minimum follow-up time of 5 years. Methods In 2012, data were retrieved from a registry of consecutive wrist operations at 7 centers with units specialized in hand surgery, between 2003 and 2007....... The wrists had been reviewed annually and analysis was done on the latest follow-up data. Results 60 patients had been operated (5 bilaterally), 5 wrists had been revised, and 52 were available for follow-up (with the revised cases excluded). The pain scores, QuickDASH scores, ulnar flexion, and supination...
Vania Regina Goveia
Full Text Available Abstract OBJECTIVE To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. METHOD A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60 surgical instruments, which were tested for endotoxins in three different stages. The EndosafeTM Gel-Clot LAL (Limulus Amebocyte Lysate method was used. RESULT There was consistent gel formation with positive analysis in eight instruments, corresponding to 13.3%, being four femoral rasps and four bone reamers. CONCLUSION Endotoxins in quantity ≥0.125 UE/mL were detected in 13.3% of the instruments tested.
Højer Karlsen, Anders Peder; Geisler, Anja; Petersen, Pernille Lykke
Treatment of postoperative pain should rely on results from randomized controlled trials and meta-analyses of high scientific quality. The efficacy of a particular intervention may depend on the type of surgical procedure, which supports the reporting of "procedure-specific" interventions. The ai......, but the available randomized placebo-controlled trials does not allow a designation of a "best proven intervention" for THA.......Treatment of postoperative pain should rely on results from randomized controlled trials and meta-analyses of high scientific quality. The efficacy of a particular intervention may depend on the type of surgical procedure, which supports the reporting of "procedure-specific" interventions. The aim...... of this systematic review was to document the procedure-specific evidence for analgesic interventions after total hip arthroplasty (THA). This PRISMA-compliant and PROSPERO-registered review includes randomized placebo-controlled trials (RCTs) of medication-based analgesic interventions after THA. Endpoints were...
Full Text Available Total hip arthroplasty through minimum anterior incision is a minimally invasive technique that allows access to the joint capsule without posting the skeletal muscle surrounding areas. Anterior surgical approach is advantageous because the hip joint is located closer to the front than the rear part of the limb. The surgical approach follows a internervous plane between superior and inferior gluteal nerves (in the side and femoral nerve (medially, without involving the muscle removal. This technique provides good access, through the same incision, both to the acetabul and the femur. It also allows better control of the acetabular cup, keeping the limb length, a decrease of dislocations rate and reduced post-operative precautions.
Rieker, Claude B.
Articulating components should minimise the generation of wear particles in order to optimize long-term survival of the prosthesis. A good understanding of tribological properties helps the orthopaedic surgeon to choose the most suitable bearing for each individual patient. Conventional and highly cross-linked polyethylene articulating either with metal or ceramic, ceramic-on-ceramic and metal-on-metal are the most commonly used bearing combinations. All combinations of bearing surface have their advantages and disadvantages. An appraisal of the individual patient’s objectives should be part of the assessment of the best bearing surface. Cite this article: Rieker CB. Tribology of total hip arthroplasty prostheses: what an orthopaedic surgeon should know. EFORT Open Rev 2016;1:52-57. DOI: 10.1302/2058-5241.1.000004. PMID:28461928
Full Text Available Objectives: To determine the effectiveness of balance exercises in the acute post-operative phase following total hip arthroplasty or total knee arthroplasty. Methods: Patients who had total hip arthroplasty (n = 30 or total knee arthroplasty (n = 33 were seen in their residence 1–2 times per week for 5 weeks. At the first post-operative home visit, patients were randomly assigned to either typical (TE, n = 33 or typical plus balance (TE + B, n = 30 exercise groups. The TE group completed seven typical surgery-specific joint range-of-motion and muscle strengthening exercises, while the TE + B group completed the typical exercises plus three balance exercises. Patients were assessed before and 5 weeks after administering the rehabilitation program using four outcome measures: (1 the Berg Balance Scale, (2 the Timed Up and Go test, (3 the Western Ontario McMaster Universities Osteoarthritis Index, and (4 the Activities-specific Balance Confidence Scale. Results: Post-intervention scores for all four outcome measures were significantly improved (p < 0.01 over baseline scores. Patients who participated in the TE + B group demonstrated significantly greater improvement on the Berg Balance Scale and the Timed Up and Go tests (p < 0.01. Conclusion: Balance exercises added to a typical rehabilitation program resulted in significantly greater improvements in balance and functional mobility compared to typical exercises alone.
Savard, G; Boudreau, C; Buchinger, F; Caggiano, J; Clark, J; Crawford, J E; Fukutani, H; Gulick, S; Hardy, J C; Heinz, A; Lee, J K P; Moore, R B; Sharma, K S; Schwartz, J; Seweryniak, D; Sprouse, G D; Vaz, J
The Canadian Penning Trap (CPT) mass spectrometer is a device used for high-precision mass measurements on short-lived isotopes. It is located at the ATLAS superconducting heavy-ion linac facility where a novel injection system, the RF gas cooler, allows fast reaction products to be decelerated, thermalized and bunched for rapid and efficient injection into the CPT. The CPT spectrometer and its injection system will be described in detail and its unique capabilities with respect to its initial physics program, concentrating on isotopes around the N=Z line with particular emphasis on isotopes of interest to low-energy tests of the electroweak interaction and the rp-process, will be highlighted. (6 refs).
Kerr, J. B.; Evans, W. F. J.
In the winters of 1987 and 1988 measurements were conducted with the Brewer Spectrophotometer at Alert (82.5 N) and Resolute (74.5 N). The measurements were conducted as part of our Canadian Program to search for an Arctic Ozone Hole (CANOZE). Ozone measurements were conducted in the months of December, January and February using the moon as a light source. The total ozone measurements will be compared with ozonesonde profiles, from ECC sondes, flown once per week from Alert and Resolute. A modified Brewer Spectrophotometer was used in a special study to search for chlorine dioxide at Alert in March 1987. Ground based observations at Saskatoon in February and at Alert in March 1987 failed to detect any measureable chlorine dioxide. Interference from another absorbing gas, which we speculate may be nitrous acid, prevented the measurements at the low levels of chlorine dioxide detected in the Southern Hemisphere by Solomon et al.
Connop, P J
Health care services for registered "band" Indians in Ontario are provided primarily by the Canadian Federal Government. Complex management methods preclude the direct involvement of Indian people in the decisions for their health resource allocation. Health indicators, need, and health status indexes are reviewed. The biostatistics of mortality and demography of the Indian and reference populations are aggregated with hospitalization/morbidity experience as the Chen G'1 Index, as an indicator of normative and comparative need. This is weighted by linear measurements of perceived need for preventive medicine programs, as ranked and scaled values of priorities, Zj. These were determined by community survey on 11 Indian reserves using a non-probabilistic psychometric method of "pair comparisons," based upon "Thurstone's Law of Comparative Judgement.," The calculation of the aggregate single unit Indian Health Status Index [Log.G'1].Zj and its potential application in a "zero-base" budget is described.
Boeckstyns, Michel E H; Herzberg, Guillaume; Merser, Søren
Background and purpose During the past 40 years, several attempts have been made with total wrist arthroplasty to avoid fusion in severely destroyed wrists. The results have often been disappointing. There is only modest clinical documentation due to the small number of patients (especially non-rheumatoid cases) and short follow-up times. Here we report a multicenter series using a third-generation implant with a minimum follow-up time of 5 years. Methods In 2012, data were retrieved from a registry of consecutive wrist operations at 7 centers with units specialized in hand surgery, between 2003 and 2007. The wrists had been reviewed annually and analysis was done on the latest follow-up data. Results 60 patients had been operated (5 bilaterally), 5 wrists had been revised, and 52 were available for follow-up (with the revised cases excluded). The pain scores, QuickDASH scores, ulnar flexion, and supination for the whole group were statistically significantly better at follow-up. There were no statistically significant differences between the rheumatoid and the non-rheumatoid patients except for motion, which was better in the non-rheumatoid group. The motion obtained depended on the preoperative motion. Implant survival was 0.9 at 5–9 years. Interpretation The clinical results in terms of pain, motion, strength, and function were similar to those in previous reports. The implant survival was 0.9 at 9 years, both in rheumatoid and non-rheumatoid cases, which is an important improvement compared to the earlier generations of total wrist arthroplasty. PMID:23848216
Elke, R; Morscher, E
In young patients with advanced necrosis of the femoral head, the short- and medium-term results of total prosthesis arthroplasty are the most satisfactory. However, the prospect of aseptic loosening hangs over such arthroplasties like Damocles' sword. Reports from the literature suggest that, in addition to the age of the patient, there is also an endogenous factor that can be responsible not only for the etiology and pathogenesis of the necrosis, but also for the early loosening of the prosthesis. We have followed up 54 patients (73 hip joints) who had total hip replacement as a result of necrosis of the femoral head between 1976 and 1988. Altogether, 3 acetabular and 5 femoral shafts had to be replaced (7 patients). This corresponds to a loosening rate of 10% after an average of 4.9 years. Hence, the prosthesis changing rate is lower than that reported by other authors, but is still higher than in patients with coxarthrosis. Only 2 of 52 cemented shaft prostheses had to be replaced; the average age of these patients was 61.4 years. Of the 21 cement-free shaft implantations, 3 had to be replaced, the average age of these patients being 42.9 years. The fact that the average age of the latter patients was lower may be the reason for the revision rate not being significantly higher for the non-cemented shafts. In view of the fact that necrosis of the femoral head can rapidly result in the patient becoming an invalid if it is allowed to follow its natural course, hip joint prostheses should also be offered to younger patients.
Road Ottawa, Ontario Canada K1A 0H3 Project Number: CSSP -2012-CD-1019 Contract Scientific Authority: Norman Yanofsky, DRDC Centre for Security...May 2014 Project: CSSP -2012-CD-1019 1 IMPORTANT INFORMATIVE STATEMENTS CSSP -2012-CD-1019 A Canadian Chemical Recovery Handbook for...Inhabited Areas was supported by the Canadian Safety and Security Program ( CSSP ) which is led by Defence Research and Development Canada’s Centre for
N. N. Kornilov
Full Text Available In the article recent publications dedicated to unicompartmental knee arthroplasty are analyzed. Evolution of indications and contraindications, mid- and late term results, difference in functional outcomes in comparison with total knee arthroplasty are discussed. Taking into consideration all relevant information unicompartmental knee arthroplasty may be considered as effective and reliable method of treatment of patients with knee osteoarthrosis and osteonecrosis.
Fransen, B.L.; van Duijvenbode, D.C.; Hoozemans, M.J.M.; Burger, B.J.
Purpose: For years, numerous studies have been performed to determine whether mobile-bearing total knee arthroplasty (MB-TKA) or fixed-bearing total knee arthroplasty (FB-TKA) is the preferential design in total knee arthroplasty. Reviews and meta-analyses on this subject have focused on a
Full Text Available The Transcultural Diabetes Nutrition Algorithm (tDNA is a clinical tool designed to facilitate implementation of therapeutic lifestyle recommendations for people with or at risk for type 2 diabetes. Cultural adaptation of evidence-based clinical practice guidelines (CPG recommendations is essential to address varied patient populations within and among diverse regions worldwide. The Canadian version of tDNA supports and targets behavioural changes to improve nutritional quality and to promote regular daily physical activity consistent with Canadian Diabetes Association CPG, as well as channelling the concomitant management of obesity, hypertension, dyslipidemia, and dysglycaemia in primary care. Assessing glycaemic index (GI (the ranking of foods by effects on postprandial blood glucose levels and glycaemic load (GL (the product of mean GI and the total carbohydrate content of a meal will be a central part of the Canadian tDNA and complement nutrition therapy by facilitating glycaemic control using specific food selections. This component can also enhance other metabolic interventions, such as reducing the need for antihyperglycaemic medication and improving the effectiveness of weight loss programs. This tDNA strategy will be adapted to the cultural specificities of the Canadian population and incorporated into the tDNA validation methodology.
Sievenpiper, John L.; Jenkins, David; Yale, Jean-François; Bell, Rhonda; Després, Jean-Pierre; Ransom, Thomas P. P.; Dupre, John; Kendall, Cyril; Hegazi, Refaat A.; Marchetti, Albert; Hamdy, Osama; Mechanick, Jeffrey I.
The Transcultural Diabetes Nutrition Algorithm (tDNA) is a clinical tool designed to facilitate implementation of therapeutic lifestyle recommendations for people with or at risk for type 2 diabetes. Cultural adaptation of evidence-based clinical practice guidelines (CPG) recommendations is essential to address varied patient populations within and among diverse regions worldwide. The Canadian version of tDNA supports and targets behavioural changes to improve nutritional quality and to promote regular daily physical activity consistent with Canadian Diabetes Association CPG, as well as channelling the concomitant management of obesity, hypertension, dyslipidemia, and dysglycaemia in primary care. Assessing glycaemic index (GI) (the ranking of foods by effects on postprandial blood glucose levels) and glycaemic load (GL) (the product of mean GI and the total carbohydrate content of a meal) will be a central part of the Canadian tDNA and complement nutrition therapy by facilitating glycaemic control using specific food selections. This component can also enhance other metabolic interventions, such as reducing the need for antihyperglycaemic medication and improving the effectiveness of weight loss programs. This tDNA strategy will be adapted to the cultural specificities of the Canadian population and incorporated into the tDNA validation methodology. PMID:24550982
Shi, Y; de Groh, M; Morrison, H; Robinson, C; Vardy, L
Almost 30% of hypertension among Canadians may be attributed to excess dietary sodium. We examined the average sodium intake of Canadians aged 30 years and over, with and without hypertension, by age, sex and diabetes status using 24-hour recall data from the 2004 Canadian Community Health Survey, Cycle 2.2, Nutrition. We compared absolute (crude) average sodium intake levels of those with and without hypertension to the 2009 Canadian Hypertension Education Program (CHEP) guidelines and adjusted average sodium intake between those with and without hypertension. Both those with and without diagnosed hypertension display average sodium intakes well above the 1500 mg/day recommended by the 2009 CHEP guidelines (2950 mg/day and 3175 mg/day, respectively). After confounding adjustment, those with hypertension have significantly higher average sodium intake (p = .0124). Stratified subgroup analyses found the average sodium intake among those with hypertension was higher for men between 30 and 49 years old (p = .0265), women between 50 and 69 years old (p = .0083) and those without diabetes (p = .0071) when compared to their counterparts without hypertension. Better approaches are needed to reduce sodium intake in hypertension patients, as well as the general population.
Pellegrini, Christine A; Ledford, Gwendolyn; Chang, Rowland W; Cameron, Kenzie A
We sought to identify patient-reported barriers and facilitators to healthy eating and physical activity among patients before or after knee arthroplasty. Twenty patients with knee osteoarthritis aged 40-79 years who had knee arthroplasty surgery scheduled or completed within 3 months were interviewed. Interview topics included perceived barriers and facilitators to healthy eating and activity before or after surgery. Interviews were coded and analyzed using constant comparative analysis. Interviews were completed with 11 pre-operative (67.1 ± 7.6 years, 45.5% female, BMI 31.2 ± 6.3) and nine post-operative patients (61.7 ± 11.7 years, 44.4% female, BMI 30.2 ± 4.7 kg/m(2)). The most commonly identified personal barriers to healthy eating identified were desire for high-fat/high-calorie foods, managing overconsumption and mood. Factors related to planning, portion control and motivation to improve health were identified as healthy eating facilitators. Identified personal barriers for activity included pain, physical limitations and lack of motivation, whereas facilitators included having motivation to improve knee symptoms/outcomes, personal commitment to activity and monitoring activity levels. Identifying specific eating and activity barriers and facilitators, such as mood and motivation to improve outcomes, provides critical insight from the patient perspective, which will aid in developing weight management programs during rehabilitation for knee arthroplasty patients. Implications for rehabilitation This study provides insight into the identified barriers and facilitators to healthy eating and physical activity in knee arthroplasty patients, both before and after surgery. Intrapersonal barriers that may hinder engagement in physical activity and rehabilitation include pain, physical limitations and lack of motivation; factors that may help to improve activity and the rehabilitation process include being motivated to improve knee outcomes
Most diversity management programs in Canada maintain that enhancing workforce diversity is of tremendous significance for business organizations in today’s competitive global urban markets. Since well-meaning diversity management initiatives have been largely ineffective thus far in dealing with workplace discrimination and racism in the Canadian workplace, this paper underscores the need to decenter the focus of diversity management from a business imperative to an antidiscrimination and so...
Patchett, Merle M; Lozowy, A
Reframing the Canadian Oil Sands” is a collaborative exchange between photographer Andriko Lozowy and cultural geographer Merle Patchett that engages photography and photographic theory to evoke a more critical and politically meaningful visual engagement with the world’s largest capital oil project. Since the appearance of Edward Burtynsky’s aerial and abstracted photographic-mappings of the region, capturing the scale of the Oil Sands from ‘on high’ has become the dominant visual imaginary....
Ramage-Morin, Pamela L; Garriguet, Didier
Nutritional risk screening is typically done in clinical settings to identify individuals at risk of malnourishment. This article presents the first population-level assessment of nutritional risk based on a large national sample representative of Canadian householders aged 65 or older. Data from the 2008/2009 Canadian Community Health Survey-Healthy Aging were used to estimate the prevalence of nutritional risk by selected characteristics. Factors associated with nutritional risk were examined with restricted and full logistic models. The distribution of responses on the SCREEN II-AB nutritional risk instrument is reported. Based on the results of the 2008/2009 survey, 34% of Canadians aged 65 or older were at nutritional risk. Women were more likely than men to be at risk. Among people with depression, 62% were at nutritional risk, compared with 33% of people without depression. Level of disability, poor oral health, and medication use were associated with nutritional risk, as were living alone, low social support, infrequent social participation, and not driving on a regular basis. Lower income and education were also associated with nutritional risk. Nutritional risk is common among seniors living in private households in Canada. The characteristics of people most likely to be at nutritional risk provide evidence for targeted screening and assessment.
Czech, Szymon; Hermanson, Jacek; Rodak, Piotr; Stołtny, Tomasz; Rodak, Łukasz; Kasperczyk, Sławomir; Koczy, Bogdan; Mielnik, Michał
An adequate level of physical activity has a substantial effect on both mental and physical human health. Physical activity is largely dependent on the function of the musculoskeletal and articular system. One of the most frequent diseases of this system is degenerative joint disease. Due to the changing and more demanding lifestyles and patients' willingness to be involved in sports activity, the expectations of hip joint arthroplasty are becoming increasingly high. Alleviating pain ceases to be the only reason for which patients choose surgical interventions, while the expectations often include involvement in various sports. Only few studies contain recommendations concerning the frequency, type and intensity of sports activity which are acceptable after hip joint arthroplasty. The aim of the study was to evaluate function and physical activity of people following cementless short-stem hip joint arthroplasty in the observation of at least five years. The study group comprised 106 patients who underwent total hip arthroplasty due to degenerative joint diseases, chosen according to inclusion criteria. Patients underwent routine physical examinations following the Harris Hip Score protocol, responded to the UCLA scale and questionnaires concerning pre-surgical and current physical activity. Our results demonstrated that hip joint arthroplasty in people suffering from degenerative joint diseases has a beneficial effect on their level of functioning and physical activity. Although physical activity and the level of functioning obviously reduced as a person aged, the level of physical activity continued to be very high in both groups, with function of the hip joint evaluated as very good.
Joao Gabriel Duarte Paes Pradella
Full Text Available OBJECTIVE: To present epidemiological data and risk factors associated with surgical out-comes favorable or unfavorable for the treatment of infection in infected total knee arthroplasty. METHODS: We reviewed medical records of 48 patients who underwent treatment of primary total knee arthroplasty for infection between January 1994 and December 2008, in the Orthopedics and Traumatology Department of the Santa Casa de Misericórdia de São Paulo. The variables associated with favorable outcome of surgical treatment (debridement and retention or exchange arthroplasty in two days or unfavorable (arthrodesis or death infection. RESULTS: A total of 39 cases of infection after primary total knee arthroplasty, 22 progressed to 17 for a favorable outcome and unfavorable outcome. Early infections (OR: 14.0, 95% CI 1.5-133.2, p = 0.016 and diabetes (OR: 11.3, 95% CI 1.4-89.3, p = 0.032 were associated with arthrodesis joint and death respectively. CONCLUSION: Patients with early infection had a higher risk of developing surgical procedure with unfavorable outcome (arthrodesis and diabetics had higher odds of death after infection of primary knee arthroplasties.
Vania Regina Goveia
Full Text Available OBJECTIVE: to characterize the epidemiological profile of patients undergoing hip replacement, primary or revisional. METHODS: we conducted a retrospective, descriptive study, including hip arthroplasties performed from January 2009 to June 2012 in a Belo Horizonte teaching hospital, Minas Gerais State - MG, Brazil. Data were analyzed using descriptive statistics. RESULTS: orthopedic procedures represented 45% of the operations at the hospital in the period, 1.4% hip arthroplasties. There were 125 hip replacements, 85 total, 27 partial and 13 reviews. Among the patients, 40% were male and 60% were female. Age ranged between 20 and 102 years, mean and median of 73 and 76 years, respectively. The most frequent diagnosis (82% was femoral neck fracture by low-energy trauma caused by falling form standing position. In 13 revision operations, 12 required removal of the prosthesis. The infectious complication led to revision in 54% of the time, followed by dislocation (15%, peri-prosthetic fracture (15% and aseptic loosening (15%. The infection etiologic agent was identified in 43% of occasions. The average length of the prosthesis to a revision operation was eight months. CONCLUSION: patients undergoing hip arthroplasty are elderly, with femoral neck fracture caused by falling form standing position, affecting more women. The incidence of hip prosthesis loosening was 10%. The main cause of the infection was loosening. The incidence of revisional hip arthroplasty was 10% and the incidence of hospital mortality in patients undergoing hip arthroplasty was 7.2%.
Mansell, Kerry; Edmunds, Kirsten; Guirguis, Lisa
The pharmacists' role in Canada has significantly advanced over the past decade, resulting in increasing access to primary care services. This study aimed to characterize pharmacists' expanded scope of practice as it relates to providing services to Canadians with diabetes. This environmental scan characterized services that could be useful to Canadians with diabetes in each of the provinces (excluding the territories): immunizations, medication prescribing, ordering and interpreting laboratory tests, and medication reviews. Researchers also collected information on pharmacists' access to health information. Data were collected from regulatory authorities in each province, from pharmacy stakeholders and through a web search. Pharmacists' scope of practice varies widely across the Canadian provinces. Three provinces have medication-review programs focused specifically on diabetes, and many people with diabetes can access publicly funded medication reviews. Other than in Quebec, pharmacists can provide influenza (publicly funded) and pneumococcal vaccinations (publicly funded in British Columbia, Alberta and Manitoba). All pharmacists in Canadian provinces can renew prescriptions to ensure continuity of therapy. Pharmacists have varying levels of other prescriptive authority. Pharmacists in all provinces (except Ontario) can access provincial prescription information; in 4 provinces, they can access laboratory results, and in 3 provinces, they can order and interpret laboratory results, such as glycated hemoglobin levels. Canadians with diabetes can expect to receive influenza vaccines and have medications renewed at their pharmacies. Many patients with diabetes qualify for a publicly funded medication review, and some provinces allow pharmacists to order and interpret laboratory results. This expanded scope provides greater opportunities for pharmacists to help support patients with diabetes in conjunction with other health-care team members. Copyright © 2017
Johanson, Per-Erik; Fenstad, Anne Marie; Furnes, Ove
The reported outcomes of hip resurfacing arthroplasty (HRA) vary. The frequency of this procedure in Denmark, Norway, and Sweden is low. We therefore determined the outcome of HRA in the NARA database, which is common to all 3 countries, and compared it to the outcome of conventional total hip ar...
Browning, H Frances; Laxer, Rachel E; Janssen, Ian
This national study was conducted to examine healthy eating programs, healthy eating education, and the food retail environments of schools. A total of 436 Canadian schools were studied. Administrators completed a questionnaire designed to assess school healthy eating programs, healthy eating education, and food retail environment. The number of chain fast food restaurants, chain cafés/coffee shops, and convenience stores within 1 km of schools was measured using geographic information systems food retailer measures from DMTI Spatial Inc. and the Yellow Pages. During the preceding year, 67% of schools had initiated healthy eating lunch programs while 18% had junk food-free days. The majority of schools offered cooking classes (59%) and healthy eating media literacy education (67%), while a minority offered gardening activities (15%) and field trips to farmers' markets (27%) and grocery stores (36%). Fifty-three percent had a school cafeteria, and most had a school tuck shop (75%) and pop/juice vending machines (76%). Fifty percent had a chain fast food restaurant, 33% had a chain café/coffee shop, and 41% had a convenience store within 1 km. An important aspect of addressing childhood obesity will be improving the food environments of schools and their surrounding neighbourhoods, and providing healthy eating education for all students.
Michael E Berend
Full Text Available The Oxford Partial Knee Replacement was approved for implantation in the US in 2004 after the surgeon completed an educational training requirement. Since then my knee practiced has expanded to over 50% partial knee. This experience coupled with refinement of surgical techniques, anesthesia protocols, and patient selection has facilitated the transformation to same day discharge for partial knee cases and has quickly transitioned to total hip, total knee, and selected revision surgeries. Patient selection has also expanded for outpatient joints and is now based on medical screening criteria and insurance access. Over a two-year period we have performed over 1,000 outpatient arthroplasty procedures with no readmissions for pain control. Overall readmission rate for all reasons was 2%. Patient satisfaction scores were 98% Great-Good for 2014-15. The combination of a partial knee replacement practice and an outpatient joint program brings the best VALUE to the patients, surgeons, and the arthroplasty system and represents the future of arthroplasty care.
Singh, Harminder; Duerksen, Donald R
OBJECTIVE: Nutrition education is a required part of gastrointestinal training programs. The involvement of gastroenterologists in clinical nutrition once their training has been completed is unknown. The aim of the present study was to determine the practice pattern of gastroenterologists in clinical nutrition and their perceived adequacy of nutrition training during their gastroenterology (GI) fellowship. METHODS: The Canadian Association of Gastroenterology mailed a survey to all of its 463 Canadian clinician members and 88 trainee members. Components of the survey included knowledge of nutritional assessment and total parenteral nutrition, involvement in a nutrition support service, physician involvement in nutritional assessment and nutrition support teams, obesity management, insertion of gastrostomy (G) tubes and management of tube-related complications, and adequacy of training in clinical nutrition. RESULTS: Sixty per cent (n=279) of the Canadian Association of Gastroenterology clinicians and 38% (n=33) of the fellows responded. Of the clinicians, 80% were practicing adult gastroenterologists with the following demographics: those practicing full time in academic centres (42%), community practice (45%), completed training in the last 10 years (32%) and those that completed training in the United States (14%). Although only 6% had a primary focus of nutrition in their GI practices, 65% were involved in nutrition support (including total parenteral nutrition), 74% placed G tubes and 68% managed at least one of the major complications of G tube insertion. Respondents felt a gastroenterologist should be the physician’s consultant on nutrition support services (89%). Areas of potential inadequate training included nutritional assessment, indications for nutrition support, management of obesity and management of G tube-related complications. The majority of clinicians (67%) and trainees (73%) felt that nutrition training in their GI fellowship was
Leung, Patrick; Kudrna, James C.
The development of pseudotumors is not uncommon with metal-on-metal total hip arthroplasty. Pseudotumors that dissect into the retroperitoneal space can cause symptoms of nerve compression. We describe a case of a 53-year-old male with a metal-on-metal total hip arthroplasty who developed mild symptoms of a femoral nerve neuropathy 6 years postoperatively. Revision arthroplasty to a ceramic-on-polyethylene articulation and debridement of the pseudotumor was performed. Postoperatively, the pat...
Hollenberg, C H
Although Canadian health care reform has constrained costs and improved efficiency, it has had a profound and mixed effect on Canadian academic medicine. Teaching hospitals have been reduced in number and size, and in patient programs have shifted to ambulatory and community settings. Specialized care programs are now multi-institutional and multidisciplinary. Furthermore, the influence of regional planning bodies has grown markedly. Although these changes have likely improved clinical servic...
This report provided information about the estimated number of consumer and household batteries sold, re-used, stored, recycled, and disposed each year in Canada. The report discussed the ways in which different batteries posed risks to human health and the environment, and legislative trends were also reviewed. Data used in the report were obtained from a literature review as well as through a series of interviews. The study showed that alkaline batteries are the most common primary batteries used by Canadians, followed by zinc carbon batteries. However, lithium primary batteries are gaining in popularity, and silver oxide and zinc air button cell batteries are also used in applications requiring a flat voltage and high energy. Secondary batteries used in laptop computers, and cell phones are often made of nickel-cadmium, nickel-metal-hydroxide, and lithium ion. Small sealed lead batteries are also commonly used in emergency lighting and alarm systems. Annual consumption statistics for all types of batteries were provided. Results of the study showed that the primary battery market is expected to decline. Total units of secondary batteries are expected to increase to 38.6 million units by 2010. The report also used a spreadsheet model to estimate the flow of consumer batteries through the Canadian waste management system. An estimated 347 million consumer batteries were discarded in 2004. By 2010, it is expected that an estimated 494 million units will be discarded by consumers. The study also considered issues related to lead, cadmium, mercury, and nickel disposal and the potential for groundwater contamination. It was concluded that neither Canada nor its provinces or territories have initiated legislative or producer responsibility programs targeting primary or secondary consumer batteries. 79 refs., 37 tabs., 1 fig.
Rodríguez-Merchán, E Carlos; Gómez-Cardero, Primitivo; Martínez-Lloreda, Ángel
Revision knee arthroplasty with a rotating-hinge design could be an option for the treatment of instability following total knee arthroplasty (TKA) in elderly patients. To evaluate the clinical and radiographic results of revision arthroplasties in TKAs with instability using a rotating-hinge design in elderly patients. We retrospectively reviewed 96 rotating-hinge arthroplasties. The average age of the patients was 79 years (range, 75-86 years); the minimum follow-up was 5 years (mean, 7.3 years; range, 5-10 years). Patients were evaluated clinically (Knee Society score) and radiographically (position of prosthetic components, signs of loosening, bone loss). At a minimum followup of 5 years (mean, 7.3 years; range, 5-10 years), Knee Society pain scores improved from 37 preoperatively to 79 postoperatively, and function scores improved from 34 to 53. ROM improved on average from -15° of extension and 80° of flexion before surgery to -5° of extension and 120° of flexion at the last followup (p = 0.03). No loosening of implants was observed. Nonprogressive radiolucent lines were identified around the femoral and tibial components in 2 knees. One patient required reoperation because of a periprosthetic infection. Revision arthroplasty with a rotating-hinge design provided substantial improvement in function and a reduction in pain in elderly patients with instability following TKA. Level IV, therapeutic study.
In this commentary, Donald Fisher reports on the history of the "The Canadian Journal of Education" as part of this 40th anniversary issue. Fisher states that the history of the Canadian Society for the Study of Education (CSSE) has been profoundly influenced by changes in the role of the Canadian State. The 1960s and 1970s were a time…
Münch, Henrik J; Jakobsen, Stig Storgaard; Olesen, Jens T
BACKGROUND AND PURPOSE: It is unclear whether delayed-type hypersensitivity reactions against implanted metals play a role in the etiopathogenesis of malfunctioning total knee arthroplasties. We therefore evaluated the association between metal allergy, defined as a positive patch test reaction...... to common metal allergens, and revision surgery in patients who underwent knee arthroplasty. PATIENTS AND METHODS: The nationwide Danish Knee Arthroplasty Register, including all knee-implanted patients and revisions in Denmark after 1997 (n = 46,407), was crosslinked with a contact allergy patch test......, the prevalence of cobalt and chromium allergy was markedly higher. Metal allergy that was diagnosed before implant surgery appeared not to increase the risk of implant failure and revision surgery. INTERPRETATION: While we could not confirm that a positive patch test reaction to common metals is associated...
Carlos Roberto Schwartsmann
Full Text Available OBJECTIVE: this was an epidemiological study on trochanteric bursitis at the time of performing total hip arthroplasty.METHODS: sixty-two sequential patients who underwent total hip arthroplasty due to osteoarthrosis, without any previous history of trochanteric bursitis, were evaluated. The bursas were collected and evaluated histologically.RESULTS: there were 35 female patients (56.5% and 27 male patients (43.5%, with a mean age of 65 years (±11. Trochanteric bursitis was conformed histologically in nine patients (14.5%, of whom six were female (66.7% and three were male (33.3%.CONCLUSIONS: 14.5% of the bursas analyzed presented inflammation at the time that the primary total hip arthroplasty due to osteoarthrosis was performed, and the majority of the cases of bursitis were detected in female patients.
Jones, D A; Lucas, H K; O'Driscoll, M; Price, C H; Wibberley, B
The significance of cobalt as a cause of symptoms after McKee hip arthroplasty is discussed. Seven patients are described in whom such arthroplasties. became unsatisfactory after periods varying from nine months to four years. Six of these patients were cobalt-positive but nickel- and chrome-negative on patch testing. Macroscopic and histological necrosis of bone, muscle and joint capsule around the prostheses was found in five patients whose hips were explored. The symptoms were progressive pain, a feeling of instability, and in two cases spontaneous dislocation. Radiological features included acetabular fracture, bone resorption, loosening and dislocation of the prosthesis. Increased cobalt concentrations (determined by atomic absorption spectrophotometry) in the urine of four patients and in a variety of tissues in one patient are presented. Patch testing is recommended in the investigation of patients with troublesome McKee hip arthroplasties
Michael Pitta, MD
Full Text Available This report describes a patient with ankylosing spondylitis (AS who underwent total hip arthroplasty (THA by the direct anterior approach and sustained a L4-5 extension fracture dislocation with neural deficits. A magnetic resonance imaging revealed an epidural hematoma at the site of the fracture causing critical stenosis. The patient was taken to the operating room for a L3-S1 posterior decompression with L2-pelvis posterior spinal fusion. AS and diffuse idiopathic skeletal hyperostosis create a stiff spine that predisposes to fractures because of the larger moment arms experienced than normal spines. The arthroplasty surgeon performing THA should be aware and take precautions to reduce stress on the spine. Keywords: Direct anterior total hip arthroplasty, Ankylosing spondylitis, Specialized table, Lumbar chance fracture, Complication
A consortium of 10 Canadian research-intensive universities launched a data exchange program in 1999 to share information that could be used to identify and evaluate the best practices of each institution and to help each institution position itself strategically to achieve its mission. One part of the program was devoted to collecting…
Full Text Available Introduction: Unicompartmental knee arthroplasty (UKA can be used to treat medial compartment osteoarthritis of the knee. Some of these knees will eventually fail, and need to be revised. There is controversy about using UKA in younger patients as a definitive procedure or as a means to delay total knee arthroplasty (TKA because the outcomes of subsequent revision surgery may be inferior to a primary TKA. Methods: We retrospectively reviewed a series of 46 revision TKA patients following failed UKA (UKA revisions using functional outcomes questionnaires and compared the results with a cohort of age and gender matched primary TKA patients. Our hypothesis was that UKA revision surgery would be inferior to primary TKA surgery. Results: Data was collected on 33 knees after a mean follow-up period of five years. There was no significant difference in the Oxford Knee Score (33.7 vs 37.1, p = 0.09 or the Western Ontario and MacMasters Universities Arthritis Index (WOMAC (24.8 vs. 19.1, p = 0.22. A subgroup analysis demonstrated that UKAs, which fail early, are more likely to produce an inferior outcome following revision surgery than those that survive more than five years. Discussion: We conclude that UKA can be used effectively in appropriately selected patients, as the functional outcome of their subsequent revision to TKA is not significantly inferior to a primary TKA.
Świtoń, Anna; Wodka-Natkaniec, Ewa; Niedźwiedzki, Łukasz; Gaździk, Tadeusz; Niedźwiedzki, Tadeusz
Coxarthrosis is a chronic musculoskeletal condition that causes severe pain and considerable limi-tation of the patient's motor performance. Total hip arthroplasty is one of the most common and effective methods used in the treatment of advanced degenerative changes. The aim of the present study was to evaluate the activity and quality of life of patients after unilateral total hip arthroplasty. The study was conducted in a group of 189 patients who had undergone unilateral total hip arthroplasty. Goniometry was used to determine the range of motion of both hip joints. Patients' physical ability and pain severity were assessed based on the Harris Hip Score (HHS) questionnaire. The examination of the range of motion in the lower extremities revealed statistically significant diffe-rences in flexion (p<0.01), abduction (p=<0.01), adduction (p<0.01) and external rotation (p<0.01) between the operated and the healthy extremity. The greatest limitation of motion was demonstrated for external rotation (<14°). Approximately 14% of the patients were not able to perform this motion in their healthy hip joint, while 17.5% of them could not do so in the affected hip joint. Analysis of HHS results (mean = 79 pts) revealed that more than 50% of the patients described their functional ability and quality of life as good and excellent. It was demonstrated that 54% of patients did not suffer from pain, whereas minor or mild pain was noted in 35%. 1. A subjective clinical assessment of patients after total hip arthroplasty showed that their quality of life had improved. 2. It is necessary to perform physiotherapy after total hip arthroplasty, on both the operated and healthy side. 3. Exacerbation of pain and impaired activity in patients after total hip arthroplasty were associated with the female sex to a considerable extent.
CCASLS) provides a shared secretariat for four area studies associations: the Canadian Association of African Studies (CAAS); the Canadian Asian Studies Association (CASA): the Canadian Association of Latin American and Caribbean Studies ...
Bistolfi, Alessandro; Zanovello, Jessica; Ferracini, Riccardo; Allisiardi, Fabrizio; Lioce, Elisa; Magistroni, Ernesta; Berchialla, Paola; Da Rold, Ilaria; Massazza, Giuseppe
to evaluate the efficacy of the use of the neuromuscular electrical stimulation (NMES) after total knee arthroplasty (TKA). a systematic review of randomized controlled trials (MEDLINE, PubMed, Cochrane Library, and PEDro) using PICOS approach to formulate the research question, Controlled terms and Boolean operators. Inclusion and exclusion criteria were defined in advance. "Neuromuscular electrical stimulation" and "total knee arthroplasty" were used as keywords. The overall risk of bias was determined according to: random sequence generation, concealment, blinding mass of participants and staff, commissioning blind assessment results, incomplete data and loans received. out of the 36 identified studies, six were included in the review (496 participants). In these studies, one group of patients followed a rehabilitation protocol (control-group) and the other followed a rehabilitation program plus a session of neuromuscular electrical stimulation (NMES-group). Patients of NMES-groups got the best scores (Timed Up and Go Test, Stair-Climbing Test and Walk Test). NMES benefits were strong in the first postoperative weeks/months and gradually diminished. NMES allows a slightly better functional recovery following TKA, especially in the first period, with more evident benefits in patients with a severe lack of muscular activation. Nevertheless, there is no difference at medium-long term.
Boeckstyns, Michel E H; Toxværd, Anders; Bansal, Manjula
tissue, the level of chrome and cobalt ions in the blood, and the possible role of infectious or rheumatoid activity in the development of PPO. METHODS: Biopsies were taken from the implant-bone interphase in 13 consecutive patients with total wrist arthroplasty and with at least 3 years' follow...... of the radiolucent zone. The blood levels of chrome and cobalt ions were normal. There was no evidence of infectious or rheumatoid activity. CONCLUSIONS: Polyethylene wear has been accepted as a major cause of osteolysis in total hip arthroplasty, and metallic debris has also been cited to be an underlying cause...
Jaspreet Kaur Nagpal
Full Text Available Bone cement implantation syndrome is a known cause of intraoperative morbidity and mortality in patients undergoing cemented arthroplasty. It is a rare but potentially fatal complication. A case of elderly female patient is reported who developed this complication during hemi arthroplasty of right hip. Within a few minutes of cementation, she developed severe hemodynamic derangement and shock with hypoxemia. Aggressive and early resuscitative measures led to a favorable outcome. Risk factors, etiopathogenesis and management of this condition are discussed in brief.
Rolfson, Ola; Bohm, Eric; Franklin, Patricia
The International Society of Arthroplasty Registries (ISAR) Patient-Reported Outcome Measures (PROMs) Working Group have evaluated and recommended best practices in the selection, administration, and interpretation of PROMs for hip and knee arthroplasty registries. The 2 generic PROMs in common use...... question ("During the past 4 weeks, how would you describe the pain you usually have in your [right/left] [hip/knee]?"; response: none, very mild, mild, moderate, or severe) and a single-item satisfaction outcome ("How satisfied are you with your [right/left] [hip/knee] replacement?"; response: very...
Pour, Aidin Eslam; Matar, Wadih Y; Jafari, S Mehdi; Purtill, James J; Austin, Matthew S; Parvizi, Javad
Hepatitis C is present worldwide. Little is known about the outcome of joint arthroplasty in asymptomatic patients with hepatitis C. We evaluated the surgical complications following hip and knee arthroplasty in patients who were seropositive for hepatitis C in a matched study. Seventy-one patients with hepatitis C underwent forty total hip arthroplasties and thirty-two total knee arthroplasties from 1995 to 2006. The patients had normal preoperative liver function tests. Patients with human immunodeficiency virus infection, hepatitis B, and hemophilia were excluded. A control group was matched in a 2:1 ratio with the hepatitis-C group for age, body-mass index, sex, year of surgery, and medical comorbidities, including diabetes, rheumatoid arthritis, and immunosuppressive conditions. In the group of patients with hepatitis C who were managed with total hip arthroplasty, six patients (15%) had wound complications requiring oral antibiotics or wound irrigation and debridement and four hips (10%) had mechanical complications, including implant loosening or dislocation. In the control group, three patients (3.8%) had wound complications requiring oral antibiotics or irrigation and debridement and three patients (3.8%) had mechanical complications, including dislocation, periprosthetic femoral fracture, and implant failure. In the group of patients with hepatitis C who underwent total knee arthroplasty, three patients (9.4%) had mechanical complications, including loosening and periprosthetic fracture requiring revision. In the control group, three patients (4.7%) had wound complications, one (1.6%) had a deep infection requiring two-stage revision, and one (1.6%) underwent revision because of a mechanical problem. The combined hepatitis-C group had significantly longer hospital stays and higher rates of surgical and mechanical complications, reoperation, and revision. Patients with hepatitis C undergoing joint arthroplasty had a higher rate of surgical complications
Thienpont, E; Lavand'homme, P; Kehlet, H
Total knee arthroplasty (TKA) is a major orthopaedic intervention. The length of a patient's stay has been progressively reduced with the introduction of enhanced recovery protocols: day-case surgery has become the ultimate challenge. This narrative review shows the potential limitations of day...... in a limited group of patients. The younger, male patient without comorbidities and with an excellent social network around him might be a candidate. Demographic changes, effective recovery programmes and less invasive surgical techniques such as unicondylar knee arthroplasty, may increase the size...
Koesters, A.; Poetzelsberger, B.; Dela, F.
The aim of this study was to monitor the long-term effects of skiing on health-related parameters and implant related factors like loosening and wear in patients with total knee arthroplasty. This paper describes the overall study design, general demographics, and physiological demand of the inte......The aim of this study was to monitor the long-term effects of skiing on health-related parameters and implant related factors like loosening and wear in patients with total knee arthroplasty. This paper describes the overall study design, general demographics, and physiological demand...
Laaksonen, Inari; Lorimer, Michelle; Gromov, Kirill
Background and purpose - Trabecular metal (TM) cups have demonstrated favorable results in acetabular revision and their use in primary total hip arthroplasty (THA) is increasing. Some evidence show that TM cups might decrease periprosthetic infection (PPI) incidence. We compared the survivorship...... of TM cups with that of other uncemented cups in primary THA, and evaluated whether the use of TM cups is associated with a lower risk of PPI. Patients and methods - 10,113 primary THAs with TM cup and 85,596 THAs with other uncemented cups from 2 high-quality national arthroplasty registries were...
Brown, Thomas D; Elkins, Jacob M; Pedersen, Douglas R; Callaghan, John J
In contemporary total hip arthroplasty, instability has been a complication in approximately 2% to 5% of primary surgeries and 5% to 10% of revisions. Due to the reduction in the incidence of wear-induced osteolysis that has been achieved over the last decade, instability now stands as the single most common reason for revision surgery. Moreover, even without frank dislocation, impingement and subluxation are implicated in a set of new concerns arising with advanced bearings, associated with the relatively unforgiving nature of many of those designs. Against that backdrop, the biomechanical factors responsible for impingement, subluxation, and dislocation remain under-investigated relative to their burden of morbidity. This manuscript outlines a 15-year program of laboratory and clinical research undertaken to improve the scientific basis for understanding total hip impingement and dislocation. The broad theme has been to systematically evaluate the role of surgical factors, implant design factors, and patient factors in predisposing total hip constructs to impinge, sublux, and/or dislocate. Because this class of adverse biomechanical events had not lent itself well to study with existing approaches, it was necessary to develop (and validate) a series of new research methodologies, relying heavily on advanced finite element formulations. Specific areas of focus have included identifying the biomechanical challenges posed by dislocation-prone patient activities, quantifying design parameter effects and component surgical positioning effects for conventional metal-on-polyethylene implant constructs, and the impingement/dislocation behavior of non-conventional constructs, quantifying the stabilizing role of the hip capsule (and of surgical repairs of capsule defects), and systematically studying impingement and edge loading of hard-on-hard bearings, fracture of ceramic liners, confounding effects of patient obesity, and subluxation-mediated worsening of third body
A. I. Yousef
Full Text Available The paper represents a review of modern foreign literature dedicated to joint replacement in patients with increased body mass index. The authors examine the epidemiology, pathogenesis features of osteoarthritis (arthrosis in obesity. The majority of experts consider the increased body mass index an aggravating factor in the surgical treatment of large joints arthrosis. There is also the opposite point of view, confirmed by many orthopedic surgeons.The analysis of publications in foreign scientific literature regarding the risk of intraand postoperative complications after arthroplasty in obese patients yields controversial results. The authors regret availability of only a few studies on such an interesting and important topic carried out in Russia. The need for a detailed study of the issues related to treatment of patients with obesity is prompted by our time.
Banerjee, Samik; Kulesha, Gene; Kester, Mark; Mont, Michael A
Additive manufacturing is an industrial technology whereby three-dimensional visual computer models are fabricated into physical components by selectively curing, depositing, or consolidating various materials in consecutive layers. Although initially developed for production of simulated models, the technology has undergone vast improvements and is currently increasingly being used for the production of end-use components in various aerospace, automotive, and biomedical specialties. The ability of this technology to be used for the manufacture of solid-mesh-foam monolithic and coated components of complex geometries previously considered unmanufacturable has attracted the attention of implant manufacturers, bioengineers, and orthopedic surgeons. Currently, there is a paucity of reports describing this fabrication method in the orthopedic literature. Therefore, we aimed to briefly describe this technology, some of the applications in other orthopedic subspecialties, its present use in hip and knee arthroplasty, and concerns with the present form of the technology. As there are few reports of clinical trials presently available, the true benefits of this technology can only be realized when studies evaluating the clinical and radiographic outcomes of cementless implants manufactured with additive manufacturing report durable fixation, less stress shielding, and better implant survivorship. Nevertheless, the authors believe that this technology holds great promise and may potentially change the conventional methods of casting, machining, and tooling for implant manufacturing in the future. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Löwik, Claudia A M; Wagenaar, Frank-Christiaan; van der Weegen, Walter; Poolman, Rudolf W; Nelissen, Rob G H H; Bulstra, Sjoerd K; Pronk, Yvette; Vermeulen, Karin M; Wouthuyzen-Bakker, Marjan; van den Akker-Scheek, Inge; Stevens, Martin; Jutte, Paul C
INTRODUCTION: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are highly successful treatment modalities for advanced osteoarthritis. However, prolonged wound leakage after arthroplasty is linked to prosthetic joint infection (PJI), which is a potentially devastating complication. On
Plans to upgrade Canadian mobile data services by introducing a full, two way mobile voice and data service, using a large geostationary satellite which is scheduled to be launched in 1994, are reported. This Mobile Satellite (MSAT) will offer customers the ability to communicate, using mobile or transportable terminals, from the most remote parts of the continent, to any other point within North America, and indeed the whole world. Currently planned MSAT services are reviewed, the main features of the overall system are outlined, and the configuration and key performance parameters of the MSAT satellite are presented. The communications subsystem is detailed, and a summary of the spacecraft service module is given.
Full Text Available The Canadian Cardiovascular Society and the Canadian Thoracic Society requested a position statement on pulmonary arterial hypertension from leading Canadian experts. The present document is intended to act as an update for the clinician, to provide a template for the initial evaluation of patients, to enable the understanding of current therapeutic paradigms based on approved indications for Canada, to highlight new therapies on the horizon, and to state the positions of the Canadian Cardiovascular Society and the Canadian Thoracic Society on resource management for pulmonary arterial hypertension in Canada.
Craig J. Della Vale
Full Text Available A user- friendly reference for decision making in complicated cases of knee arthroplasty desingned in a question and answers format composed of articles containing current concepts and preferences of experts in total knee replacement surgery, enhanced by several images, diagrams and references and written in the form of a casual advice by Craig J. Della Vale, MD. and his collaborators. PURPOSE By this practical reference of knee arthroplasty, the editor and the contributors have aimed providing straightforward and brief answers, evidence-based advices, their preference and opinions containing current concepts for unanswered questions about complicated cases in total knee replacement surgery which are often controversial and not addressed clearly in traditional knee arthroplasty references. FEATURES There are 49 subjects each written by a different expert designed in 4 sections in a question and answers format including several images and diagrams and also essential references at the end of each article. In the first section preoperative questions is subjected including indications, unicompartmental osteoarthritis of the knee, patient with vascular problems, donating blood, bilateral arthroplasty, patellar resurfacing, range of motion, bearing surface, contraindications, teaching class for patients prior surgery. The second section is about intraoperative questions including skin incision, patella femoral maltracking, femoral component rotation, tibial component rotation, lateral release, femoral component sizing, flexion instability, varus deformity, and valgus deformity, tightness in extension, iatrogenic MCL injury, antibiotic-loaded cement, and perioperative pain. The third section subjects postoperative questions including wound drainage, preventing tromboembolic events, vascular complications, foot drop, manipulation under anesthesia, patella fractures, supracondylar femur fractures, acute extensor mechanism disruptions. In the fourth
CASID and Canadian Journal of Development Studies : Organizational Strengthening 2007-2010. The Canadian Association for the Study of International Development (CASID) is a national, bilingual, multidisciplinary and pluralistic association devoted to the study of international development in all parts of the world.
fabrication, PWC assembly & test, automatic backplane wiring, computerized wire History : AEI, an established Canadian company for over 55...production of Automatic Number Identification (ANI) systems and 911 Emergency History : Aeo Machining Ltd is a small machining company Reporting Systems for...Aircraft, DeHavilland, Grumman Aircraft, and Canadian Digital Radar Data Processing - Contract with Fundacao Vickers Ltd. Educacional de Bauru, Brazil
... 47 Telecommunication 5 2010-10-01 2010-10-01 false Canadian registration. 90.121 Section 90.121 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND SPECIAL RADIO SERVICES PRIVATE LAND MOBILE RADIO SERVICES Applications and Authorizations § 90.121 Canadian registration. Form 410 shall be...
Laye, Adele M.; Mykota, David B.
Exposure to physical violence is an unfortunate reality for many Canadian youth as it is associated with numerous negative psychosocial effects. The study aims to assist in understanding resilience in rural Canadian youth exposed to physical violence. This is accomplished by identifying the importance of protective factors, as measured by the…
Tyser, Andrew R; Tsai, Michael A; Parks, Brent G; Means, Kenneth R
To compare stability and range of motion after hemi-hamate reconstruction versus volar plate arthroplasty in a biomechanical proximal interphalangeal (PIP) joint fracture-dislocation model. Eighteen digits from 6 cadaver hands were tested. We created defects of 40%, 60%, and 80% in the palmar base of each digit's middle phalanx, simulating an acute PIP joint fracture-dislocation. Each defect scenario was reconstructed with a hemi-hamate arthroplasty followed by a volar plate arthroplasty. A computer-controlled mechanism was used to bring each digit's PIP joint from full extension to full flexion via the digital tendons in each testing state, and in the intact state. During each testing scenario we collected PIP joint cinedata in a true lateral projection using mini-fluoroscopy. A digital radiography program was used to measure the amount of middle phalanx dorsal translation (subluxation) in full PIP joint extension. We recorded the angle at which subluxation, if present, occurred during each testing scenario. Average dorsal displacement of the middle phalanx in relation to the proximal phalanx was 0.01 mm for the hemi-hamate reconstructed joints and -0.03 mm for the volar plate arthroplasty, compared with the intact state. Flexion contractures were noted in each of the specimens reconstructed with volar plate arthroplasty. Degree of contracture was directly correlated with defect size, averaging 20° for 40% defects, 35° for 60% defects, and 60° for 80% defects. We observed no flexion contractures in the hemi-hamate reconstructions. Surgeons can use both hemi-hamate and volar plate arthroplasty to restore PIP joint stability following a fracture dislocation with a large middle phalanx palmar base defect. Use of volar plate arthroplasty led to an increasing flexion contracture as the middle phalanx palmar base defect increased. Clinicians can use the information from this study to help with surgical decision-making and patient education. Copyright © 2015
Grabovac, Andrea D; Ganesan, Soma
Mental health professionals are increasingly aware of the need to incorporate a patient's religious and spiritual beliefs into mental health assessments and treatment plans. Recent changes in assessment and treatment guidelines in the US have resulted in corresponding curricular changes, with at least 16 US psychiatric residency programs now offering formal training in religious and spiritual issues. We present a survey of training currently available to Canadian residents in psychiatry and propose a lecture series to enhance existing training. We surveyed all 16 psychiatry residency programs in Canada to determine the extent of currently available training in religion and spirituality as they pertain to psychiatry. We received responses from 14 programs. Of these, 4 had no formal training in this area. Another 4 had mandatory academic lectures dedicated to the interface of religion, spirituality, and psychiatry. Nine programs offered some degree of elective, case-based supervision. Currently, most Canadian programs offer minimal instruction on issues pertaining to the interface of religion, spirituality, and psychiatry. A lecture series focusing on religious and spiritual issues is needed to address this apparent gap in curricula across the country. Therefore, we propose a 10-session lecture series and outline its content. Including this lecture series in core curricula will introduce residents in psychiatry to religious and spiritual issues as they pertain to clinical practice.
Díaz Miñarro, J C; Izquierdo Fernández, A; Muñoz Reyes, F; Carpintero Lluch, R; Uceda Carrascosa, P; Muñoz Luna, F; López Jordán, A; Carpintero Benítez, P
Reverse shoulder arthroplasty is becoming a useful tool for many diseases of the shoulder. Any severe glenoid bone defect may affect the fixing of the glenoid component. The aim of this paper is to evaluate the medium-term outcomes of reverse shoulder arthroplasty associated with a glenoplasty. A retrospective study was conducted on 5 patients from our hospital, selected due to glenoid defects of different etiology. All of them where treated with reverse shoulder arthroplasty associated with glenoplasty with bone graft. The minimum follow-up was one year (mean 30.4 months). All grafts were radiologically integrated, with no signs of resorption or necrosis being observed. At 12 months, the Constant score was 66.75 and the mean EVA score was 1. Glenoplasty surgery is technically demanding for restoring original bone size in patients with glenoid structural defects, enabling a reverse shoulder arthroplasty to be implanted. Thus improving both the function and clinical outcomes in selected patients with glenohumeral pathology and providing them with a solution. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.
Introduction: Orthopaedic surgery results in significant blood loss. There are no studies that can aid the surgeon in the African region estimate the expected blood loss after total hip replacement. We conducted a study to quantify the blood loss following total hip arthroplasty and to determine the factors associated with this ...
Brooks, Elaine; Freter, Susan H; Bowles, Susan K; Amirault, David
Pain management after elective arthroplasty in older adults is complicated due to the risk of undertreatment of postoperative pain and potential adverse effects from analgesics, notably opioids. Using combinations of analgesics has been proposed as potentially beneficial to achieve pain control with lower opioid doses. We compared a multimodal pain protocol with a traditional one, in older elective arthroplasty patients, measuring self-rated pain, incidence of postoperative delirium, quantity and cost of opioid analgesics consumed. One hundred fifty-eight patients, 70 years and older, admitted to tertiary care for elective arthroplasty were prospectively assessed postoperative days 1-3. Patients received either traditional postoperative analgesia (acetaminophen plus opioids) or a multimodal pain protocol (acetaminophen, opioids, gabapentin, celecoxib), depending on surgeon preference. Self-rated pain, postoperative delirium, and time to achieve standby-assist ambulation were compared, as were total opioid doses and analgesic costs. Despite receiving significantly more opioid analgesics (traditional: 166.4 mg morphine-equivalents; multimodal: 442 mg morphine equivalents; t = 10.64, P multimodal group ( t = 9.15, P multimodal approach to pain control demonstrated no benefit over traditional postoperative analgesia in elective arthroplasty patients, but with significantly higher amounts of opioid consumed. This poses a potential risk regarding tolerability in frail older adults and results in increased drug costs.
Pain is uncommon. Early diagnosis and treatment are crucial if the worst sequelae of this condition are to be avoided. Surgery of TMJ ankylosis needs careful evaluation and planning to yield predictable results. Ankylosis may be corrected surgically by an array of procedures like gap arthroplasty, joint reconstruction and ...
de Man, F. Harald R.; Haverkamp, Daniel; van der Vis, Harm M.; Besselaar, Philip P.; Marti, René K.
Total hip arthroplasty in hypoplastic femurs is technically difficult and the incidence of complications and aseptic loosening is relatively high. Cemented, uncemented, off-the-shelf, and custom-made stems all have been advocated in these cases. From 1978 to 1997, we performed 86 total hip
Husted, Henrik; Gromov, Kirill; Malchau, Henrik
of NSAIDs, early mobilization, allowing early travel, and a low hemoglobin trigger for transfusion. Interpretation - Revision of traditions and myths surrounding hip and knee arthroplasty towards more contemporary evidence-based principles can be expected to improve early functional recovery, thus reducing...
Kort, Nanne Pieter; Van Raay, Jos J. J. A. M.; van Horn, Jim R.
Popliteal vascular injury and the compartment syndrome of the leg are rare but important complications of knee arthroplasties. Early diagnosis and treatment are of paramount importance in preventing the devastating complications of these conditions. To our knowledge, these complications have not
The average age was 66 years with a 1:1.6 male female ratio. The most common indication was osteoarthritis. Two complications were encountered; surgical site infection and post-operative cerebrovascular accident. There were no dislocations. Conclusions: The posterior approach is a viable approach for hip arthroplasty ...
Clements, Warren J; Miller, Lisa; Whitehouse, Sarah L; Graves, Stephen E; Ryan, Philip
Background Patella resurfacing in total knee arthroplasty is a contentious issue. The literature suggests that resurfacing of the patella is based on surgeon preference, and little is known about the role and timing of resurfacing and how this affects outcomes. Methods We analyzed 134,799 total knee arthroplasties using data from the Australian Orthopaedic Association National Joint Replacement Registry. Hazards ratios (HRs) were used to compare rates of early revision between patella resurfacing at the primary procedure (the resurfacing group, R) and primary arthroplasty without resurfacing (no-resurfacing group, NR). We also analyzed the outcomes of NR that were revised for isolated patella addition. Results At 5 years, the R group showed a lower revision rate than the NR group: cumulative per cent revision (CPR) 3.1% and 4.0%, respectively (HR = 0.75, p patella only” revisions were more common in the NR group (29%) than in the R group (6%). Non-resurfaced knees revised for isolated patella addition had a higher revision rate than patella resurfacing at the primary procedure, with a 4-year CPR of 15% and 2.8%, respectively (HR = 4.1, p patella was not resurfaced, and suggest that surgeons may be inclined to resurface later if there is patellofemoral pain. However, 15% of non-resurfaced knees revised for patella addition are re-revised by 4 years. Our results suggest an early beneficial outcome for patella resurfacing at primary arthroplasty based on revision rates up to 5 years. PMID:19968604
Sep 11, 2017 ... Introduction:Total Hip Arthroplasties (THA) have been carried out in East Africa for over two decades. Data from. European and American centres suggests that cemented implants have survivorship of over 80% at 25 years. There is a paucity of data concerning survivorship of implants in Africa. This study ...
van den Akker-Scheek, Inge; Stevens, Martin; Bulstra, Sjoerd K.; Groothoff, Johan W.; van Horn, Jim R.; Zijlstra, Wiebren
Objective: To describe recovery of gait after total hip arthroplasty (THA) based on the assessment of spatiotemporal gait parameters determined with an ambulatory system. Design: A 6-month inception cohort study. Setting: Inpatient and outpatient setting in an academic hospital. Participants:
Gylvin, Silas Hinsch; Fink-Jensen, Anders; Kehlet, Henrik
BACKGROUND: Psychiatric conditions and psychopharmacological treatments have been demonstrated to be important risk-factors for prolonged hospital length of stay, readmission and morbidity, following fast-track total hip (THA) and total knee arthroplasty (TKA). AIMS: The aim of the study was to p...
Omar M. Ghanem
Full Text Available Axillary artery injury has been associated with shoulder dislocation and surgery. We describe a case of delayed axillary artery occlusion after reverse total shoulder arthroplasty. The injury was confirmed by Doppler and angiography and was treated with angioplasty and stenting. Early recognition and treatment of this injury are mandatory for patients’ recovery.
Papalia, Rocco; Del Buono, Angelo; Zampogna, Biagio; Maffulli, Nicola; Denaro, Vincenzo
Although the clinical and functional outcomes of patients undergoing knee arthroplasty have widely been investigated, there is little information on the postoperative sport activity status. We performed a comprehensive search of CINAHL, Embase, Medline and the Cochrane Central Registry of Controlled Trials, from inception of the database to 25 February 2011, using various combinations of the keyword terms 'Knee arthroplasty', 'Knee replacement', 'Total Knee replacement', 'Unicondylar Knee replacement', 'Knee Prosthesis', 'Sport Activity', 'Return To Sport Activity Level' and 'Recreational Sporting Level'. Twenty-two articles published in peer-reviewed journals were included in this review. Patients report improved outcomes, in terms of pain, symptoms, activities of daily living, sport activity and quality of life, compared with preoperative status. Only low-impact physical activities are recommended. The Coleman Methodology Score showed great heterogeneity in the study design, patients' characteristics, management methods and outcome assessment, and generally low methodological quality. Data are too heterogeneous to allow for definitive conclusions on long-term outcomes of total knee arthroplasty. It is not possible to compare the post-operative sport activity status of the patients. Validated and standardized measures should be used to report outcomes of patients undergoing knee arthroplasty. Function surveys that better depict sport activities, and include actual physical function testing, should be used. There is a need to perform appropriately powered randomized clinical trials using standard diagnostic assessment, and a common and validated scoring system comparing reported outcomes and the duration of follow-up >2 years.
Krenk, Lene; Rasmussen, L S; Hansen, T B
hospital stay and medical morbidity. No data on PD are available in fast-track surgery. The aim of this study was to evaluate the incidence of PD after fast-track hip (THA) and knee arthroplasty (TKA) with anticipated length of stay (LOS) of In a prospective multicentre study to evaluate postoperative...
Moustafa Abdelaziz Moustafa
Mar 2, 2012 ... ORIGINAL ARTICLE. Nalbuphine added to intrathecal morphine in total knee arthroplasty; effect on postoperative analgesic requirements and morphine related side effects. Moustafa Abdelaziz Moustafa *, Rabab Saber Saleh. Faculty of Medicine, Anaesthesia and Surgical Intensive Care, Alexandria, ...
Kristensen, M.; Pötzelsberger, B.; Scheiber, P.
We investigated the effect of alpine skiing for 12 weeks on skeletal muscle characteristics and biomarkers of glucose homeostasis and cardiovascular risk factors. Twenty-three patients with a total knee arthroplasty (TKA) were studied 2.9 ± 0.9 years (mean ± SD) after the operation. Fourteen...
Boonstra, M.C.; Waal Malefijt, M.C. de; Verdonschot, N.J.J.
Total knee arthroplasty (TKA) is being undertaken in a younger population than before and as a result the functional demands on the knee are likely to be increasing. As a consequence, it is important to define quantitative functional knee tests that can monitor any increase. A valuable functional
Major, Tibor; Bikov, András; Holnapy, Gergely; Bejek, Zoltán; Bakos, Bernadett; Szendrői, Miklós; Skaliczki, Gábor
Several studies have been published which questioned the use of suction drain during elective hip arthroplasty. In this prospective study the authors examined how the use of suction drainage affected complications related to perioperative blood loss and hemorrhage in patients undergoing elective hip arthroplasty. Eighty-six patients undergoing elective hip arthroplasty were divided into two groups. In 54 patients ("drain" group) suction drains were used during operation, whereas in 32 patients no suction drain was applied. Perioperative blood loss, use of tranexamic acid, method of thrombosis prophylaxis, transfusion requirement, incidental postoperative hemorrhage, septic complications, and all other postoperative complications were recorded. Perioperative blood loss was affected with the use of tranexamic acid but not with the use of drainage (p = 0.94). Patients without the use of drain showed a tendency of lower transfusion requirement (p = 0.08). There was no correlation between any complications and the use of drainage. In accordance with published results the authors conclude that the routine use of suction drainage during elective hip arthroplasty is not definitely necessary. Orv. Hetil., 2016, 157(29), 1171-1176.
Amir Reza Kachooei
Distal radioulnar joint injuries are disabling and patients usually undergo one or more salvage surgeries prior to receiving an arthroplasty. The Scheker prosthesis has shown satisfactory results with 100% survival rate in all reports. The constrained design of this prosthesis gives enough stability to prevent painful subluxation.
Lindberg-Larsen, Martin; Jørgensen, Christoffer Calov; Husted, Henrik
PURPOSE: The aim of this nationwide study was to investigate the early morbidity after bilateral simultaneous and staged total knee arthroplasty (TKA) in order to clarify potential benefits of a well-established fast-track regime. METHODS: The Danish National Patient Registry was searched for all...
Matziolis, G; Röhner, E
Aseptic loosening seems to have become a minor problem in total knee arthroplasty. In contrast to that, new challenges are defined by changing patients' expectations. Beside reduction of pain and improving mobility, modern implants should not be noticed as such and should not limit sports activities. In this paper, a summary of the development and the current situation of total knee arthroplasty (e.g., implantation numbers, hospitality, operation time, and infection rates) are provided. The data are compared in an international context. In addition, current trends and developments from recent years are shown and rated according to the literature. The paper is based on a literature search (PubMed) and analyses of published official statistical data and expert recommendations. Implantation numbers have been declining gradually in Germany since 2009. In 2013, 127,077 total knee arthroplasties were implanted. In contrast, the number of revision operations has increased gradually during the last decade. In addition, hospital stay and operation time have declined. The development of implants, instruments, and operation techniques results from changing patients' expectations. All innovations must be compared against the results of well-proven techniques. The arthroplasty register may be an instrument to evaluate the results of new techniques and implants in a broad clinical application in terms of survival.
D. V. Nenashev
Full Text Available The retrospective analysis of 97 shoulder arthroplasties during 1998 to 2009 was performed. The hemiarthroplasty were fulfilled in 92 patients and total shoulder replacement in 5 patients. Total rate good and satisfactory results consists 32,0%, poor results - 68,0% (66 patients, include 5 patients with total shoulder arthroplasty. The lower level of good results was revealed in patients with chronic fractures and fracture-dislocations of shoulder. It related with changes bones of shoulder and muscles of shoulder (rotator cuff. In the studied group of patients there was no proper pre-operative diagnostics of the rotator cuff, articular surface of the scapula, which shows the need for careful preoperative examination to determine the indications for shoulder arthroplasty and select the type of prosthesis. Unsatisfactory results of total arthroplasty related to screw migration (in case of the transacromion approach and to the development of subacromial impingement. The conclusion about the need to narrow the indications for use of the scapular component «Ortho-P». The authors showed preference to cemented implants without a metal base. It is necessary to introduce in practice the anatomic implants of the third generation allowing the fullest play the anatomy and biomechanics of the shoulder joint.
Klit, Jakob; Jacobsen, Steffen; Schmiegelow, Victoria
In this prospective multicentre cohort study we studied subjects younger than 60 years of age scheduled for primary total hip arthroplasty (THA). The study assessed patients' overall satisfaction, fulfillment of preoperative expectations, the effect on socioeconomic parameters, and quality of sex...
Ready, Kathryn; Keshavjee, Serena
Education is the self-declared "heart" of the Canadian Museum for Human Rights (CMHR), already generating partnership projects and programs with such organizations as the Canadian Teachers' Federation, the Assembly of First Nations, the Inuit Tapiriit Kanatami, and the Robert F. Kennedy Center for Justice and Human Rights. The CMHR has…
Full Text Available Background/Aim. Infected total knee arthroplasty (TKA is a topic of great importance, because its diagnosing and treatment requires a lot of resources, and often has an unsatisfactory outcome. The aim of this study was to analyze the outcome of the treatment of infection developed following TKA. Methods. This retrospective study of infected TKAs was performed in the period from 1998 to 2008 in the Orthopedics & Traumatology Clinic of the Military Medical Academy (MMA in Belgrade. A total of 654 primary and revised TKAs were performed in the said period. We registered and surgically treated 28 infected TKAs (primary TKAs: MMA - 22, other institutions - 6. The incidence of TKA infection in the MMA was 3.36%. The most common pathogens were: Staphylococcus aureus - 14 (50% cases, and Staph. epidermidis - 3 (10.7% cases. Other isolated pathogens were: Enterococcus faecalis, Klebsiella pneum., Klebsiella spp., Streptoccocus viridans, Seratia spp, Micrococcus luteus and Peptostreptococcus spp. In one case we had mixed anaerobic flora, and in 3 cases cultures were negative. We analyzed diagnostic challenges, risk factors (such as age and previous viscosupplementation and treatment outcomes in our series of infected TKAs. Results. In our series 2 infections healed after iv antibiotics and debridement, 1 patient responded to open debridement with component retention, 4 patients responded fully to one-stage reimplantation, 10 cases responded fully to two-stage reimplantation, 11 patients ended with arthrodesis and we had 1 patient with above knee amputation. Conclusion. Two-stage reimplantation remains gold standard for treatment of infected TKA, and we recommend it as treatment of choice for eradication of infection. The antibiotic loaded spacer prothesis concept in most cases allows infection eradication, good function and high patient satisfaction.
G. M. Kavalersky
Full Text Available In recent years, there is a trend of increasing demand for revision hip arthroplasty. Among these patients there are many with complex acetabular defects, including patients with pelvic discontinuity. To ensure stability for revised acetabular components in such cases becomes a challenging or unachievable task. Such defects give indications for printing customized tri-flange acetabular component. The authors analysed own experience of creating and applying custom made acetabular components in 3 patients with complex acetabular defects. Material and methods. Among the patients there were 2 women and 1 man. Average age was 60,3±19,4 years (38 to 78 years. Two patients had III B defects with pelvic discontinuity and one patient had III A defect by Paprosky classification. As the first step, the authors in collaboration with engineers printed a plaster full size pelvic 3D model, as the second step a customized tri-flange acetabular component was designed and printed. Harris Hip Score was evaluated preoperatively and 3 months postoperatively. Results. Average follow-up period was 5,3±2,5 months (3 to 8 months. The authors observed no cases of implant loosening, dislocation or deep periprosthetic infection. Average Harris Hip Score before surgery was 27,13 and after surgery – 74,1 indicating a significant improvement in 3 months postoperatively. Conclusion. Indications for use of individual acetabular components in reported patients correspond to indications formulated by Berasi et al. The authors obtained encouraging early follow-up outcomes that correspond to data of other authors. In one patient certain difficulties were reported due to insufficient pelvic distraction. Component’s flanges prevented achieving adequate pelvic distraction. Nevertheless, good primary stability was achieved. Modern software and 3D metal printers can significantly reduce the production cost of customized acetabular components. Application of this technology can be
Chalmers, Peter N; Rahman, Zain; Romeo, Anthony A; Nicholson, Gregory P
Although instability can occur after reverse total shoulder arthroplasty (RTSA), the risk factors, the treatment, and ultimate fate of the implant in these patients remains poorly understood. Demographics, acute treatment, and the need for revision were evaluated in all patients with RTSAs who sustained a subsequent dislocation within the first 3 months. Standardized outcome scores were collected preoperatively and at the final follow-up. Atraumatic instability occurred in 11 patients (incidence, 2.9%) treated with RTSA early (before 3 months postsurgery). The mean time to dislocation was 3.4 weeks. These patients tended to be previously operated-on (64%), male (82%), overweight (mean body mass index (BMI) of 32.2 kg/m(2), with 82% having a BMI ≥30 kg/m(2)), and without a satisfactory subscapularis repair at initial RTSA (64%). Initial treatment included closed reduction in 9 patients, open reduction in 1, and open reduction with a thicker polyethylene insert in 1. Four experienced recurrent instability requiring a thicker polyethylene insert. Two additional patients were converted to hemiarthroplasty due to persistent instability. Visual analog pain scores (P = .014) and American Shoulder and Elbow Surgeons scores (P = .018) were significantly improved. Simple Shoulder Test scores trended towards improvement (P = .073). Early dislocations of the RTSA prosthesis were uncommon. The most common associated factors were a BMI >30 kg/m(2), male gender, subscapularis deficiency, and previous surgery; in these patients, we now use an abduction orthosis. Closed reduction alone was successful in 4 of the 9 closed reductions (44%). Five of 11 RTSAs (45%) required polyethylene exchange. The RTSA was retained in 82%, 36% with the original implant. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.
Russell, Evan; Hall, Andrew Koch; Hagel, Carly; Petrosoniak, Andrew; Dagnone, Jeffrey Damon; Howes, Daniel
Simulation-based education (SBE) is an important training strategy in emergency medicine (EM) postgraduate programs. This study sought to characterize the use of simulation in FRCPC-EM residency programs across Canada. A national survey was administered to residents and knowledgeable program representatives (PRs) at all Canadian FRCPC-EM programs. Survey question themes included simulation program characteristics, the frequency of resident participation, the location and administration of SBE, institutional barriers, interprofessional involvement, content, assessment strategies, and attitudes about SBE. Resident and PR response rates were 63% (203/321) and 100% (16/16), respectively. Residents reported a median of 20 (range 0-150) hours of annual simulation training, with 52% of residents indicating that the time dedicated to simulation training met their needs. PRs reported the frequency of SBE sessions ranging from weekly to every 6 months, with 15 (94%) programs having an established simulation curriculum. Two (13%) of the programs used simulation for resident assessment, although 15 (94%) of PRs indicated that they would be comfortable with simulation-based assessment. The most common PR-identified barriers to administering simulation were a lack of protected faculty time (75%) and a lack of faculty experience with simulation (56%). Interprofessional involvement in simulation was strongly valued by both residents and PRs. SBE is frequently used by Canadian FRCPC-EM residency programs. However, there exists considerable variability in the structure, frequency, and timing of simulation-based activities. As programs transition to competency-based medical education, national organizations and collaborations should consider the variability in how SBE is administered.
Haslam, S; Yen, D; Dvirnik, N; Engen, D
A large number of patients presenting for total hip and knee arthroplasty report an allergy to penicillin. the reported incidence of cross reactions with cephalosporins in patients with penicillin allergy ranges from 3% to 18%. Perioperative antibiotic prophylaxis practices range from using cephalosporins to substituting clindamycin or vancomycin. the purpose of this study was to determine whether cefazolin can be used safely in the perioperative setting in patients with reported non-IgE mediated reactions to penicillin. We retrospectively reviewed all primary total hip and knee arthroplasty (2012) and revision (278) cases done at a canadian university hospital from 2007 to 2010. We calculated the prevalence of reported penicillin allergy, the specific reaction reported, and the observed reaction rate in penicillin allergic patients given cefazolin. The prevalence of reported penicillin allergy was 9.9%. there was a wide range of reported reactions, with 25% IgE mediated and 75% non-IgE mediated. Only 27% of patients reporting penicillin allergies were given cefazolin. there were no adverse reactions when non-IgE mediated penicillin allergy patients received cefazolin. surgical patients with reported non-IgE allergic reactions to penicillin have a low chance of adverse reaction to perioperative administration of cefazolin. Only a fraction of surgical patients with reported non-IgE mediated reactions to penicillin receive cefazolin perioperatively.
Full Text Available Background. The United Kingdom Global Rating Scale (GRS-UK measures unit-level quality metrics processes in digestive endoscopy. We evaluated the psychometric properties of its Canadian version (GRS-C, endorsed by the Canadian Association of Gastroenterology (CAG. Methods. Prospective data collection at three Canadian endoscopy units assessed GRS-C validity, reliability, and responsiveness to change according to responses provided by physicians, endoscopy nurses, and administrative personnel. These responses were compared to national CAG endoscopic quality guidelines and GRS-UK statements. Results. Most respondents identified the overarching theme each GRS-C item targeted, confirming face validity. Content validity was suggested as 18 out of 23 key CAG endoscopic quality indicators (78%, 95% CI: 56–93% were addressed in the GRS-C; statements not included pertained to educational programs and competency monitoring. Concordance ranged 75–100% comparing GRS-C and GRS-UK ratings. Test-retest reliability Kappa scores ranged 0.60–0.83, while responsiveness to change scores at 6 months after intervention implementations were greater (P<0.001 in two out of three units. Conclusion. The GRS-C exhibits satisfactory metrics, supporting its use in a national quality initiative aimed at improving processes in endoscopy units. Data collection from more units and linking to actual patient outcomes are required to ensure that GRS-C implementation facilitates improved patient care.
Dyer, L. [SNC Group, Montreal, PQ (Canada)
Various hydroelectric power projects in southern African countries that have benefited from Canadian expertise and assistance under the Southern African Development Community (SADC) AAA.3.4 Hydroelectric Hydrological Assistance Project, were described. The project aims to upgrade the operational hydrology units of the SADC hydroelectric utilities in the Zambezi River Basin, focusing particularly on improving the quality, availability, accessibility and utility of the hydrometric data used for inflow forecasting and inventory purposes. The data is also used for planning and operations. A current usage is to assess the sustainability of the systems implemented under the program. BC Hydro, and the Water Survey of Canada are the principal Canadian agencies involved in providing the technical expertise. Increased confidence in inflow forecasts, increased energy production, reduced loss of water due to unnecessary spilling, improved ability to safely route floods, and to cope with droughts, and improved data for design and dam safety studies are just some of the benefits derived from this example of Canadian technical assistance in the developing countries. 12 refs., 6 tabs., 4 figs.
Gascoyne, M.; Kamineni, D. C.
The composition of groundwater has been determined in selected granitic, gabbroic and gneissic plutons in the Canadian Shield as part of the Canadian Nuclear Fuel Waste Management Program. A similar geochemical evolution of the groundwater is seen with increasing depth or with flow along the hydraulic gradient, irrespective of rock type. This pattern is comparable to that seen in mine groundwaters from throughout the Canadian Shield. Near-surface groundwaters are typically dilute, slightly alkaline and Ca-(Na)-HCO3 in composition. They evolve to higher pH, Na-(Ca)-HCO3 compositions along the flow path because of interaction with plagioclase, calcite precipitation and ion exchange on clay minerals. At greater depths (>≈200 m), groundwater salinity increases as a result of the dissolution of Cl-rich salts in the rock matrix and, in certain areas, mixing with Na-Cl brines from seawater or basinal formation water. Stable and radioactive isotopic data for the groundwaters help to interpret these characteristics and indicate high residence times for the deeper, saline groundwater.
Locke, Jennifer; Robinson, Michael; MacNeily, Andrew; Goldenberg, S Larry; Black, Peter C
Robotic-assisted laparoscopic surgery (RAS) has not been adopted as rapidly or widely in Canada as in the U.S. In 2011, Canadian urology residents felt that RAS represented an expanding field that could potentially negatively impact their training. We re-evaluate trainee exposure and attitudes to RAS in Canadian residency training five years later. All Canadian urology residents were asked to participate in an online survey designed to assess current resident exposure to and perception of RAS. The response rate was 39% (61/157). Seventy-seven percent of residents reported being involved in at least one RAS procedure (52% in 2011), and the majority had exposure to <10 cases. For those in hospitals with access to RAS, 96% desired more console time, while only 50% of those without access wanted more console experience. Of all residents, 50% felt that RAS will become the gold standard in certain urological surgeries (34% in 2011), but only 28% felt that RAS would play an increasingly important role in urology (59% in 2011). Despite an increase in exposure to RAS in residency programs over the past five years, console experience remains limited. Although these residents desire more access to RAS, many voice uncertainty of the role of RAS in Canada. We cannot conclude whether RAS is perceived by residents to be beneficial or detrimental to their training nationwide. Moving forward in the robotic era, it will be important to either modify residency curricula to address RAS experience or to limit RAS to fellowship training.
Full Text Available An adequate level of physical activity has a substantial effect on both mental and physical human health. Physical activity is largely dependent on the function of the musculoskeletal and articular system. One of the most frequent diseases of this system is degenerative joint disease. Due to the changing and more demanding lifestyles and patients’ willingness to be involved in sports activity, the expectations of hip joint arthroplasty are becoming increasingly high. Alleviating pain ceases to be the only reason for which patients choose surgical interventions, while the expectations often include involvement in various sports. Only few studies contain recommendations concerning the frequency, type and intensity of sports activity which are acceptable after hip joint arthroplasty. The aim of the study was to evaluate function and physical activity of people following cementless short-stem hip joint arthroplasty in the observation of at least five years. The study group comprised 106 patients who underwent total hip arthroplasty due to degenerative joint diseases, chosen according to inclusion criteria. Patients underwent routine physical examinations following the Harris Hip Score protocol, responded to the UCLA scale and questionnaires concerning pre-surgical and current physical activity. Our results demonstrated that hip joint arthroplasty in people suffering from degenerative joint diseases has a beneficial effect on their level of functioning and physical activity. Although physical activity and the level of functioning obviously reduced as a person aged, the level of physical activity continued to be very high in both groups, with function of the hip joint evaluated as very good.
Kolber, Marcin K.; Shukla, Pratik A.; Kumar, Abhishek; Zybulewski, Adam; Markowitz, Todd; Silberzweig, James E., E-mail: email@example.com [Mount Sinai Beth Israel, Division of Vascular and Interventional Radiology, Department of Radiology (United States)
PurposeRecurrent spontaneous hemarthrosis is an infrequent but debilitating late complication of joint replacement, affecting up to 1.6% of patients with arthroplasty of the affected joint. Repeated episodes of bleeding result in an inflammatory cascade that further propagates bleeding events. Open and arthroscopic synovectomy are often performed when conservative treatments fail. Transarterial embolization is increasingly utilized as a less invasive option; however, its role is not widely established. We performed a systematic literature review to report the safety and efficacy of transarterial embolization in treating recurrent hemarthrosis in the setting of prior arthroplasty.Materials and MethodsA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A structured search was performed in PubMed, Web of Science, Embase, and SCOPUS databases of patients undergoing embolization for recurrent hemarthrosis after arthroplasty. Patients immediately post-operative, those embolized at first bleeding episode, and those with hemophilia were excluded. Demographic data, clinical information, angiographic findings, treatment, and outcomes were tabulated.ResultsThe search identified 119 titles of which 24 were deemed relevant, comprising 91 patients undergoing 99 embolization procedures. Mean time from prosthesis implantation was 32.2 months. Technical success was 99%. Mean follow-up time was 24.9 months. There were 10 recurrences (10%). Two cases were complicated by joint infection requiring arthroplasty revision.ConclusionsTransarterial embolization for recurrent spontaneous hemarthrosis may be safe and effective in patients having undergone arthroplasty of the affected joint.
Kopeć, Konrad; Kusz, Damian; Sobota, Grzegorz; Nowak, Karina; Mierzwiński, Maciej; Nowak, Mariusz
Osteoarthritis (OA) is the most common joint pathology and the main cause of disability in elderly persons. Arthroplasty still remains the most effective treatment of OA. Routine post-operative patient assessment does not include an objective functional examination leading to conclusions regarding the need of further rehabilitation. This role is played by gait analysis performed in patients after arthroplasty. The aim of the study was to conduct a quantitative and qualitative analysis of selected gait parameters in patients after unilateral cementless hip arthroplasty. The study involved a group of 16 patients who were examined before and after hip arthroplasty. Gait analysis was conducted before surgery and at least 6 months after the procedure. The Smart DX BTS system for spatial gait analysis was used. The duration of the stance phase on the affected side was 63.8 [% gait cycle] and was significantly shorter (pgait cycle]. After surgery, the duration of swing phase on the unaffected side increased (pgait cycle]. A statistically significant change was also found in the double support phase (the arthrotic limb as the front limb), which was markedly shortened. The average length of a single and double step, cadence, average gait velocity, and the velocity of leg swing in the swing phase increased. The range of hip mobility increased in all planes, especially in the sagittal plane. The space and time gait parameters with regard to the operated leg after hip arthroplasty indicate an improvement as compared with the baseline results; however, they do not reach the values found in healthy persons.
Kooijman, HJ; Driessen, APPM; van Horn, [No Value
We studied retrospectively the outcome of patellofemoral arthroplasty (PFA) using the Richards prosthesis in 51 patients (56 knees). Their mean age was 50 years (30 to 77). In 43 patients (45 knees), the American Knee Society score and the patients' subjective judgement were assessed. Excellent or
Hartel, B.P.; Alta, T.D.; Sewnath, M.E.; Willems, W.J.H.
INTRODUCTION: The increase of shoulder replacements will lead to a higher revision rate of shoulder arthroplasties. The aim of this study is to evaluate the clinical results of revision surgery performed in our hospital, distinguish the differences in clinical outcome according to revision
Postoperative improvement in health-related quality of life: a national comparison of surgical treatment for focal (one- to two-level) lumbar spinal stenosis compared with total joint arthroplasty for osteoarthritis.
Rampersaud, Y Raja; Wai, Eugene K; Fisher, Charles G; Yee, Albert J M; Dvorak, Marcel F S; Finkelstein, Joel A; Gandhi, Rajiv; Abraham, Edward P; Lewis, Stephen J; Alexander, David I; Oxner, William M; Davey, J R; Mahomed, Nizar
The results of single-center studies have shown that surgical intervention for lumbar spinal stenosis yielded comparable health-related quality of life (HRQoL) improvement to total joint arthroplasty (TJA). Whether these results are generalizable to routine clinical practice in Canada is unknown. The primary purpose of this equivalence study was to compare the relative improvement in physical HRQoL after surgery for focal lumbar spinal stenosis (FLSS) compared with TJA for hip and knee osteoarthritis (OA) across six Canadian centers. A Canadian multicenter ambispective cohort study. A cohort of 371 primary one- to two-level spinal decompression (n=214 with instrumented fusion) for FLSS (n=179 with degenerative lumbar spondylolisthesis [DLS]) was compared with a cohort of primary total hip (n=156) and knee (n=208) arthroplasty for OA. The primary outcome was the change in preoperative to 2-year postoperative 36-Item Short Form Health Survey Physical Component Summary (PCS) score as reflected by the number of patients reaching minimal clinically important difference (MCID) and substantial clinical benefit (SCB). Univariate analyses were conducted to identify baseline differences and factors that were significantly related to outcomes at 2 years. Multivariable regression modeling was used as our primary analysis to compare outcomes between groups. The mean age (years) and percent females for the spine, hip, and knee groups were 63.3/58.5, 66.0/46.9, and 65.8/64.3, respectively. All three groups experienced significant improvement of baseline PCS (pHRQoL after surgical treatment of FLSS (including DLS) is consistently achieved nationally. Our overall results demonstrate that a comparable number of patients can expect to achieve MCID and SCB 2 years after surgical intervention for FLSS and total knee arthroplasty. Copyright © 2011 Elsevier Inc. All rights reserved.
Ree, M; Riediger, N; Moghadasian, M H
To establish health-related reasons behind Canadian food choices, and how variables such as education, income, gender, ethnicity and age may affect food selection. Approximately 98 733 Canadians responded to the 12 questions regarding food choices in the Canadian Community Health Survey (CCHS) cycle 2.1, conducted by the Canadian Government in 2003. These included 13 727 adolescents (12-19 years), 19 089 young adults (20-34 years), 31 039 middle-aged adults (35-54 years), 25 338 older adults (55-74 years) and 9580 elderly (75+ years). Approximately 70% of Canadian adolescents in the sample indicated that their food choices were independent of health concerns. Body weight management was a major concern for food selection by adolescents and adults, while the elderly stated heart disease as their main concern. Among all participants, females, and individuals with high levels of education and income reported the highest response to choosing or avoiding foods due to health concerns and food content. Our data indicate that several factors significantly affect food choices for health-related reasons in the Canadian population. Among them, age- and gender-related gaps, particularly between adolescents and adults, are profound. This observation may urge authorities to implement effective strategies to educate Canadians, especially adolescents, that selection of appropriate foods may prevent chronic diseases.
Macpherson, John A. [Atomic Energy of Canada Limited, Ottawa (Canada)
Times have changed since the early days of nuclear energy when it was a symbol of a brave new world, Public information strategies have evolved to meet increasing public concerns, and have shifted from being a largely unfocused attempt at publicity to being more concerned with managing issues and solving problems. This paper describes some of the salient features of the Canadian experience in nuclear communications and examines four key aspects: opinion and attitude research; media relations; coeducation; and advertising. It also addresses the challenge of responding to the allegations and tactics of those who are actively hostile to nuclear energy, and recommends that the principles of Total Quality Management and of organizational effectiveness be applied more thorough and more consistently to the public affairs function.
Hemmings, R.L. [Canatom NPM (Canada)
An overview of the various tritium research and operational activities in Canada is presented. These activities encompass tritium processing and recovery, tritium interactions with materials, and tritium health and safety. Many of these on-going activities form a sound basis for the tritium use and handling aspects of the ITER project. Tritium management within the CANDU heavy water reactor, associated detritiation facilities, research and development facilities, and commercial industry and improving the understanding of tritium behaviour in humans and the environment remain the focus of a long-standing Canadian interest in tritium. While there have been changes in the application of this knowledge and experience over time, the operating experience and the supporting research and development continue to provide for improved plant and facility operations, an improved understanding of tritium safety issues, and improved products and tools that facilitate tritium management. (author)
Palmer, Neal G; Yacyshyn, James R; Northcott, Herbert C; Nebbe, Brian; Flores-Mir, Carlos; Major, Paul W
An anonymous, self-administered, mail-out survey of Canadian Orthodontists was conducted to evaluate the characteristics of orthodontic Internet use. The response rate was 45.6% (304 of 667). A total of 76.6% of orthodontists reported having Internet access at work, and an additional 12.4% reported having Internet access from a different location. Statistically significant associations between Internet usage and office staff size (P < .001) and years of practice (P = .046) were observed. Offices with larger staffs had greater Internet access. Number of staffs and number of case starts were positively correlated (P < .001, r = 0.498). The odds ratio for having Internet access on the basis of increased case starts from the less than 100 to 300-399 categories was 5.67. Although not statistically significant, there was a trend for greater Internet access by younger practitioners.
Werner, Birgit S; Boehm, Dorota; Gohlke, Frank
Background Revision in failed shoulder arthroplasty often requires removal of the humeral component with a significant risk of fracture and bone loss. Newer modular systems allow conversion from anatomic to reverse shoulder arthroplasty with retention of a well-fixed humeral stem. We report on a prospectively evaluated series of conversions from hemiarthroplasty to reverse shoulder arthroplasty. Methods In 14 cases of failed hemiarthroplasty due to rotator cuff deficiency and painful pseudopa...
Merolla, G; Nastrucci, G; Porcellini, G
Shoulder arthroplasty is a technically demanding procedure to restore shoulder function in patients with severe osteoarthritis of the glenohumeral joint. The modern prosthetic system exploit the benefits of modularity and the availibility of additional sizes of the prosthetic components. In this paper we describe the biomechanics of shoulder arthroplasty and the technique for shoulder replacement including total shoulder arthroplasty (TSA) with all-polyethylene and metal-backed glenoid component, humeral head resurfacing and stemless humeral replacement. PMID:24251240
Ponce, Brent A; Oladeji, Lasun O; Rogers, Mark E; Menendez, Mariano E
The rate of shoulder arthroplasty has continued to increase at an exponential rate during the past decade in large part owing to approval by the Food and Drug Administration of reverse shoulder arthroplasty. Whereas reverse shoulder arthroplasty has resulted in expanded surgical indications, there are numerous reports of relatively high complication rates. The increased prevalence of both anatomic and reverse shoulder arthroplasty underscores the need to elucidate whether perioperative outcomes are influenced by type of total shoulder arthroplasty. The purpose of this study was to determine the impact of shoulder arthroplasty type, anatomic or reverse, with respect to perioperative adverse events, in-hospital death, prolonged hospital stay, nonroutine disposition, and hospital charges in a nationally representative sample. By use of the Nationwide Inpatient Sample database from 2011, the first year that reverse total shoulder arthroplasty received a unique International Classification of Diseases, Ninth Revision procedure code, an estimated 51,052 patients undergoing total shoulder arthroplasty were separated into anatomic total shoulder arthroplasty (58%) and reverse total shoulder arthroplasty (43%). Comparisons of early outcome measures between anatomic and reverse total shoulder cohorts were performed by bivariate and multivariable analyses with logistic regression modeling. Compared with anatomic shoulder arthroplasty recipients, patients undergoing reverse shoulder replacement were at higher risk for in-hospital death, multiple perioperative complications, prolonged hospital stay, increased hospital cost, and nonroutine discharge. Despite the expanding indications for reverse shoulder arthroplasty, it is an independent risk factor for inpatient morbidity, mortality, and hospital costs and should perhaps be offered more judiciously and performed in the hands of appropriately trained shoulder specialists. Copyright © 2015 Journal of Shoulder and Elbow Surgery
This project aims to strengthen the capacity of Canadian civil society organizations (CSOs) to inform Canadian policy on human rights and global justice. The Canadian Council for International Co-operation (CCIC) receives core funding from the Canadian International Development Agency (CIDA). This grant will provide ...
Kösters, A; Rieder, F; Wiesinger, H-P; Dorn, U; Hofstaedter, T; Fink, C; Müller, E; Seynnes, O R
The aim of this study was to investigate the effect of alpine skiing on patellar tendon properties in patients with total knee arthroplasty (TKA). Thirty-one adults (70.4 ± 4.7 years) with unilateral TKA were recruited 2.7 ± 0.9 years after surgery and assigned to an intervention (IG) or a control group (CG). The IG underwent a 12-week guided skiing program. Tendon stiffness, Young's modulus, and cross-sectional area (CSA) were measured before and after the intervention. In both groups, mean tendon CSA was 28% (P alpine skiing appears to offer a suitable rehabilitation strategy for TKA patients. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Snyman, Gretchen; Tucker, Joseph E L; Cimini, Massimo; Narine, Kishan; Fedak, Paul W M
Barriers to successful innovation can be identified and potentially addressed by exploring the perspectives of key stakeholders in the innovation process. Cardiac surgeons in Canada were surveyed for personal perspectives on biomedical innovation. Quantitative data was obtained by questionnaire and qualitative data via interviews with selected survey participants. Surgeons were asked to self-identify into 1 of 3 categories: "innovator," "early adopter," or "late adopter," and data were compared between groups. Most surgeons viewed innovation favourably and this effect was consistent irrespective of perceived level of innovativeness. Key barriers to the innovation pathway were identified: (1) support from colleagues and institutions; (2) Canada's health system; (3) sufficient investment capital; and (4) the culture of innovation within the local environment. Knowledge of the innovation process was perceived differently based on self-reported innovativeness. The majority of surgeons did not perceive themselves as having the necessary knowledge and skills to effectively translate innovative ideas to clinical practice. In general, responses indicate support for implementation of leadership and training programs focusing on the innovation process in an effort to prepare surgeons and enhance their ability to successfully innovate and translate new therapies. The perspectives of cardiac surgeons provide an intriguing portal into the challenges and opportunities for healthcare innovation in Canada. Copyright © 2012 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
Johnson, Mike; Davidson, Jim; Mortensen, Paul
In a relatively new development over just the past few years, shale formations are being targeted for natural gas production. Based on initial results, there may be significant potential for shale gas in various regions of Canada, not only in traditional areas of conventional production but also non-traditional areas. However, there is much uncertainty because most Canadian shale gas production is currently in experimental or early developmental stages. Thus, its full potential will not be known for some time. If exploitation proves to be successful, Canadian shale gas may partially offset projected long-term declines in Canadian conventional natural gas production.
Chivers, Quinton J; Ahmad, Jamil; Lista, Frank; Warren, Richard J; Arkoubi, Amr Y; Mahabir, Raman C; Murray, Kenneth A; Islur, Avinash
With the demand for cosmetic surgery continuing to rise, it is necessary to reevaluate the current state of cosmetic surgery training during plastic surgery residency. An evaluation of cosmetic surgery training in US plastic surgery residency programs in 2006 identified several areas for improvement, resulting in changes to both the duration and content of training. The authors assess the current state of cosmetic surgery training in Canadian plastic surgery residency programs. A paper survey of all graduating Canadian plastic surgery residents eligible to complete the 2009 Royal College of Physicians and Surgeons of Canada fellowship examinations was performed (N = 29). The survey was conducted primarily at the Canadian Plastic Surgery Review Course in February 2009, with surveys collected from absent residents by e-mail within 1 month after the course. The survey covered 2 broad areas: (1) specifics regarding resident cosmetic surgery training and (2) confidence and satisfaction associated with this experience. Of the 29 residents surveyed, 28 responded (96%). The majority of Canadian plastic surgery residency programs (75%) have a designated cosmetic surgery rotation, but 90% of respondents felt it has become increasingly difficult to gain exposure to cosmetic procedures as most are performed at private surgery centers. Elective rotations at cosmetic surgery practices and resident cosmetic clinics were considered the most beneficial for cosmetic surgery education. Residents considered cosmetic surgery procedures of the face (such as rhinoplasty and facelift) more challenging, but they had more confidence with breast and body contouring procedures. Canadian plastic surgery residency programs need to ensure that residents continue to receive comprehensive exposure to both surgical and nonsurgical cosmetic procedures to ensure our specialty's continued leadership in this evolving and highly competitive field. A multidimensional approach utilizing a variety of
Kim, Daniel J; Theoret, Jonathan; Liao, Michael M; Kendall, John L
Starting in 2008, emergency ultrasound (EUS) was introduced as a core competency to the Royal College of Physicians and Surgeons of Canada (Royal College) emergency medicine (EM) training standards. The Royal College accredits postgraduate EM specialty training in Canada through 5-year residency programs. The objective of this study is to describe both the current experience with and the perceptions of EUS by Canadian Royal College EM senior residents. This was a web-based survey conducted from January to March 2011 of all 39 Canadian Royal College postgraduate fifth-year (PGY-5) EM residents. Main outcome measures were characteristics of EUS training and perceptions of EUS. Survey response rate was 95% (37/39). EUS was part of the formal residency curriculum for 86% of respondents (32/37). Residents most commonly received training in focused assessment with sonography for trauma, intrauterine pregnancy, abdominal aortic aneurysm, cardiac, and procedural guidance. Although the most commonly provided instructional material (86% [32/37]) was an ultrasound course, 73% (27/37) of residents used educational resources outside of residency training to supplement their ultrasound knowledge. Most residents (95% [35/37]) made clinical decisions and patient dispositions based on their EUS interpretation without a consultative study by radiology. Residents had very favorable perceptions and opinions of EUS. EUS training in Royal College EM programs was prevalent and perceived favorably by residents, but there was heterogeneity in resident training and practice of EUS. This suggests variability in both the level and quality of EUS training in Canadian Royal College EM residency programs. [West J Emerg Med. 2014;15(3):306-311.].
To examine the ability of recent Canadian ophthalmology graduates to commence clinical practice and obtain surgical privileges. A secondary objective was to assess their perception of the adequacy of their residency training. An Internet questionnaire survey. Canadian graduates of Canadian ophthalmology residency programs between 2005 and 2009, inclusive. Email addresses for the participants were obtained from the Canadian Ophthalmological Society and invitations to participate were sent, followed by 2 reminder emails. A 44% response rate was obtained (65 out of 154 emails sent). Of the respondents, 91% were working full time, and 89% had operating-room time. Training was adequate for all CanMEDs competencies except working as a manager. Assessment that one's practice did not live up to expectations correlated with male gender, dissatisfaction with location, inability to get operating-room time, inability to get other hospital resources, feelings about fairness of distribution of resources, and net income below expectations. For the most part, recent graduates are successful in establishing practices that meet their expectations. Training in management skills should be improved in residency programs. Copyright © 2012 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
Kwon, Dae Gyu; Chung, Chin Youb; Park, Moon Seok; Sung, Ki Hyuk; Kim, Tae Won; Lee, Kyoung Min
Total ankle arthroplasty and arthrodesis are the two mainstreams of treatment for end-stage ankle arthritis. This study was performed to determine which is a better choice for ankle arthritis, using a decision analysis and Markov model to reflect the repetitive nature of revision arthroplasty. Based on current published evidence, a decision tree was constructed to compare the clinical outcomes of total ankle arthroplasty and arthrodesis, which contained the possible clinical events and the probabilities. Total ankle arthroplasty was subject to revision arthroplasty, and a Markov model was adopted for this branch to reflect this repetitive trait of the procedure. Arthrodesis could cause adjacent arthritis, and a conventional decision analysis model was adopted for this branch. Quality well-being index score was used for clinical outcome assessment, which was the utility in the decision tree. Sensitivity analysis was performed to test the stability of the decision tree and the threshold values. The model favoured total ankle arthroplasty over arthrodesis in terms of quality well-being index score. Sensitivity analysis showed that the model was considerably stable, unaffected by the changes in probabilities of failure after total ankle arthroplasty and adjacent arthritis after arthrodesis. Based on current evidence, total ankle arthroplasty was found to be a better treatment than arthrodesis for ankle arthritis. Future development in the implant materials, improved understanding of ankle biomechanics, and surgical techniques will further enhance the clinical outcome of total ankle arthroplasty.
Brian J. Cole
limited prosthetic resurfacing. Section VI is "Operative treatment-elbow" including chapters arthroscopy, nonprosthetic elbow arthroplasty, biological resurfacing. The Section VII is "Operative treatment-foot and ankle" including chapters about ankle arthroscopy and cartilage repair in the ankle.The text is one of the most comprehensive and up-to-date references in the treatment of cartilage pathologies and biological joint reconstruction. Some other minimal invasive surgical techniques such as prosthetic partial resurfacing or some osteotomies are also subjected as other alternative treatments for joint restoration. Basic sciences, diagnostic imaging, pharmacological treatment and neutraceuticals, and rehabilitation are making the text. The chapter about future developments in cartilage repair is not only describing the recent technology, different types of tissue engineering and related centers in the world but also gives an idea for the possibilities of future in cartilage repair. Chapters about surgical techniques and procedures are uniformly composed of parts including introduction, preoperative evaluation, surgical technique, postoperative issues, results and references in which the techniques and management described in detail. Numerous high quality images, rich illustrations and figures, page design and also colored tables about key points, protocols, or helpful hints makes the reading and understanding easier
Goveia, Vania Regina; Mendoza, Isabel Yovana Quispe; Guimarães, Gilberto Lima; Ercole, Flavia Falci; Couto, Bráulio Roberto Gonçalves Marinho; Leite, Edna Marilea Meireles; Stoianoff, Maria Aparecida Resende; Ferreira, José Antonio Guimarães
To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60 surgical instruments, which were tested for endotoxins in three different stages. The EndosafeTM Gel-Clot LAL (Limulus Amebocyte Lysate method) was used. There was consistent gel formation with positive analysis in eight instruments, corresponding to 13.3%, being four femoral rasps and four bone reamers. Endotoxins in quantity ≥0.125 UE/mL were detected in 13.3% of the instruments tested. Investigar endotoxinas em instrumentais cirúrgicos esterilizados empregados em artroplastias do quadril. Estudo exploratório, descritivo, desenvolvido em um hospital público de ensino. Foram selecionados seis tipos de instrumentais, a saber: raspa acetabular, raspa femural, saca-cabeça de fêmur, formão box, fresa de fêmur e cabeça de prova de fêmur. A seleção foi feita a partir da análise da dificuldade para a remoção de resíduos de sangue e osso durante a limpeza. A amostra foi constituída por 60 instrumentais cirúrgicos, que foram testados para endotoxinas em três momentos distintos. Foi utilizado o método de gel-clot pelo Limulus Amebócito Lisado (LAL) Endosafe(tm). Houve formação de gel consistente com análise positiva em oito instrumentais, o que corresponde a 13,3%, sendo quatro raspas de fêmur e quatro fresas de fêmur. Foram detectadas endotoxinas em quantidade ≥0,125 UE/mL em 13,3% dos instrumentais testados.
Scott, C E H; MacDonald, D; Moran, M; White, T O; Patton, J T; Keating, J F
To evaluate the outcomes of cemented total hip arthroplasty (THA) following a fracture of the acetabulum, with evaluation of risk factors and comparison with a patient group with no history of fracture. Between 1992 and 2016, 49 patients (33 male) with mean age of 57 years (25 to 87) underwent cemented THA at a mean of 6.5 years (0.1 to 25) following acetabular fracture. A total of 38 had undergone surgical fixation and 11 had been treated non-operatively; 13 patients died at a mean of 10.2 years after THA (0.6 to 19). Patients were assessed pre-operatively, at one year and at final follow-up (mean 9.1 years, 0.5 to 23) using the Oxford Hip Score (OHS). Implant survivorship was assessed. An age and gender-matched cohort of THAs performed for non-traumatic osteoarthritis (OA) or avascular necrosis (AVN) (n = 98) were used to compare complications and patient-reported outcome measures (PROMs). The mean time from fracture to THA was significantly shorter for patients with AVN (2.2 years) or protrusio (2.2 years) than those with post-traumatic OA (9.4 years) or infection (8.0 years) (p = 0.03). Nine contained and four uncontained defects were managed with autograft (n = 11), bulk allograft (n = 1), or trabecular metal augment (n = 1). Initial fracture management (open reduction and internal fixation or non-operative), timing of THA (>// 10 mm) were significantly higher following acetabular fracture compared with atraumatic OA/AVN and OHSs were inferior: one-year OHS (35.7 v ersus 40.2, p = 0.026); and final follow-up OHS (33.6 v ersus 40.9, p = 0.008). Cemented THA is a reasonable option for the sequelae of acetabular fracture. Higher complication rates and poorer PROMs, compared with patients undergoing THA for atraumatic causes, reflects the complex nature of these cases. Cite this article: Bone Joint J 2017;99-B:1399-1408. ©2017 The British Editorial Society of Bone & Joint Surgery.
Zustin, Jozef; Sauter, Guido [University Medical Centre Hamburg-Eppendorf, Institute of Pathology, Hamburg (Germany); Hahn, Michael [University Medical Centre Hamburg-Eppendorf, Center for Biomechanics and Skeletal Biology, Hamburg (Germany); Morlock, Michael M. [TUHH Hamburg University of Technology, Biomechanics Section, Hamburg (Germany); Ruether, Wolfgang [University Medical Centre Hamburg-Eppendorf, Department of Orthopaedics, Hamburg (Germany); Amling, Michael [University Medical Centre Hamburg-Eppendorf, Center for Biomechanics and Skeletal Biology, Hamburg (Germany); University Medical Centre Hamburg-Eppendorf, Department of Trauma, Hand and Reconstructive Surgery, Hamburg (Germany)
Before the re-introduction of the current generation of total hip resurfacing arthroplasty, component loosening and osteolysis were of great concern to the orthopaedic community. Early, mid- and long-term clinical results are encouraging, but component loosening still exists. Macroscopic, contact radiographic and histopathological analyses after undecalcified preparation of bone tissue specimens were performed. To investigate the frequency and morphological patterns of the loosening of the femoral component, we analysed a series of 190 retrieved femoral remnants that were revised for aseptic failures. Thirty-five (18.4%) hips were revised for clinical and/or radiographic loosening of the femoral component. Pseudoarthrosis (n = 17; median in situ time: 16 weeks, interquartile range [IQR]: 9 to 34), collapsed osteonecrosis (n = 5; median in situ time: 79 weeks, IQR: 63 to 97), cement-socket debonding (n = 3; median in situ time: 89 weeks, IQR: 54 to 97) and at later follow-up bone-cement loosening (n = 10; median in situ time: 175 weeks; IQR 112 to 198; p =0.005) were distinct patterns of the femoral remnant-implant loosening. Fibrocartilaginous metaplasia of interface bone trabeculae (n = 38; median in situ time: 61 weeks, IQR: 32 to 138) was strongly associated with femoral component loosening (p = 0.009). Both the trabecular hyperosteoidosis (n = 32; median in situ time: 71 weeks, IQR 50 to 129) and excessive intraosseous lymphocyte infiltration (n = 12; median in situ time: 75 weeks, IQR 51 to 98) at the bone-cement interface correlated strongly with fibrocartilaginous metaplasia (p = 0.001 and p = 0.016 respectively) and all three lesions were associated with the female gender (p = 0.021, p = 0.009, and p = 0.051). Femoral component loosening at early follow-up was mostly caused by pathological changes of the femoral remnant bone tissue: pseudoarthrosis and collapsed osteonecrosis. Fibrocartilaginous metaplasia was frequently observed in hips with femoral
Sahay, Sarita; Piran, Niva
Examines skin-color preferences and body satisfaction among South Asian-Canadian and European-Canadian female university students. Hypothesizes that South Asian-Canadians would display a greater wish to be lighter in skin color than would European-Canadians and that the discrepancy would be greater the darker their skin color. Reports that the…
Geraldo Motta Filho
Full Text Available OBJETIVO: Determinar as características clínico-cirúrgicas referentes a 145 artroplastias do ombro realizadas no período entre julho de 2004 a dezembro de 2006. MÉTODOS: No período de estudo foram realizadas 145 artroplastias de ombro. Através de protocolo prospectivo, informações demográficas, da anamnese, exame físico e exame radiográfico foram armazenadas em um banco de dados. Os dados coletados foram organizados em três grandes grupos: doenças articulares degenerativas, fraturas e seqüelas traumáticas. Esses dados foram correlacionados a fim de definir o perfil epidemiológico dos pacientes, das lesões e artroplastias. RESULTADOS: Das 145 artroplastias de ombro realizadas 37% foram por seqüelas traumáticas, 30% por doença articular degenerativa e 33% com diagnóstico de fratura. Foram 12% artroplastias totais e 88% parciais. Ocorreram cinco complicações no pós-operatório recente. CONCLUSÃO: As artroplastias de ombro tornaram-se um procedimento frequente na prática ortopédica. Registros cirúrgicos são importantes a fim de demonstrar essa evolução progressiva e permitir avaliações de resultados clínicos no futuro.OBJECTIVE: The study's objective is to evaluate the characteristics and problems of patients who underwent shoulder arthroplasties between July 2004 and November 2006. METHODOLOGY: During the period of the study, 145 shoulder arthroplasties were performed. A prospective protocol was used for every patient; demographic, clinical and surgical procedure data were collected. All gathered data were included in the data base. The patients were divided in three major groups: fractures, degenerative diseases and trauma sequels. Information obtained from the data base was correlated in order to determine patients' epidemiologic, injuries, and surgical procedure profiles. RESULTS: Of the 145 shoulder arthroplasties performed, 37% presented trauma sequels, 30% degenerative diseases, and 33% proximal humerus
Sapra, Priya; Rosen, Cheryl; Siddha, Sanjay; Lynde, Charles W
The management of dysplastic nevi is controversial. No studies have collected data regarding management of the lesion amongst Canadian dermatologists. To provide a comprehensive review of what the prevailing opinions are, regarding treatment and terminology of dysplastic nevi, amongst Canadian dermatologists. An online survey of 25 questions was e-mailed to 613 members of the Canadian Dermatology Association, in French and English. A total of 179 responses were received. Varying numbers of participants completed each question. The majority of participants think that the term dysplastic nevus should not be abandoned, and they indicated that they never reexcise lesions with mild to moderate atypia even when the margins are positive. The majority of Canadian dermatologists retain the use of the term dysplastic nevus and do not reexcise lesions with mild to moderate atypia even when the margins are positive. © The Author(s) 2015.
Bollivar, D.R; Cadegan, E; Demone, E.H; Matthew, P; Nicholson, P.J; Shannon, C.P; Stirling, R.C
This report was prepared for the Nova Scotia Fish Packers Association in an effort to set out as clearly as possible the issues relating to introduction of freezing at sea technology to the Canadian...
...), as part of its mandate to provide analysis of potential impacts of trends and change on defense and defense related issues, has designed a prototype model of recruitment and attrition of the Canadian Forces (C F...
Dobni, Dawn; Dobni, Brooke
Using Porter's five-forces model (potential entrants, suppliers, buyers, rivalry, substitutes) to analyze competition in Canadian university business schools, the authors conclude that schools are becoming increasingly vulnerable to competitive pressures and that strategic reorientation is necessary. (SK)
After the Second World War ended, Canada was no longer mainly composed of its two dominant ethnocultural groups, French and English, but rather constituted by polyethnicity; meaning, Canadian culture was made up of many different ethnic groups. Since then, Canada has actively embraced multiculturalism and on 12 July 1988, the House of Commons passed Bill C-93, ‘An Act for the preservation and enhancement of multiculturalism in Canada’. The Canadian multicultural experience has been much portr...
General implications for counseling Asian immigrant women were sought through individual and group counseling at King Edward Campus of Vancouver Community College. The campus is the base for the centralized English as a second language program for new Canadian adults in British Columbia. The research focused in part on nine women who were tested…
Haave, Neil C.
Capstone experiences have high educational impact with various approaches available for biology. However, no information exists regarding the pervasiveness of capstone courses in Canadian and American biology programs. This study surveyed the prevalence and character of biology capstone courses in the USA and Canada. The survey included a majority…
This paper discusses the development and implementation of the VISUNET:CANADA Partners Program, an innovative, cooperative model of library service for blind and print disabled Canadians. The ultimate purpose of the model is to advance information equity for blind and print disabled individuals, wherever they live, by positioning the local library…
Dubuc-Charbonneau, Nicole; Durand-Bush, Natalie; Forneris, Tanya
The purpose of the current study was to examine the levels of burnout among student-athletes at two Canadian universities and to investigate whether there were significant differences related to gender, sport, year of university sport participation, academic year, and academic program. Burnout was measured by administering Raedeke and Smith's…
Leinweber, K.; Donlevy, J. K.; Gereluk, D.; Patterson, P.; Brar, J.
This paper asks the question, "What is the current status of provincial moral education polices in the five Canadian provinces which have mandated or optional moral education programs: Saskatchewan, Ontario, Quebec, British Columbia, and Alberta?" It then offers a response through an analysis of the relevant policies in those provinces…
Araújo, Paulo; Machado, Luís; Cadavez, Duarte; Mónaco, Lisete; Januário, Filipa; Luís, Lisete; Bártolo, Mafalda
To assess the function and quality of life in patients undergoing total hip arthroplasty distinguishing two surgical approaches (posterior / anterolateral) used by the Orthopedics department of Centro Hospitalar de Leiria. Retrospective study of 94 patients subject to unilateral hip replacement surgery, using the 'Hip Osteoarthritis Outcome Score' (HOOS LK 2.0) questionnaire, the Trendelenburg test and evaluation of muscle strength of the hip abductor muscles with dynamometer. Patients were evaluated at six months, 12 months, 18 months and 24 months after surgery. The study revealed that 97.9% patients completed the rehabilitation program. The postoperative evolution (six to 24 months) does not appear to have any differences in results when comparing both approaches. At six months the patient operated by the anterolateral approach showed worse results when compared with the posterior approach, in particular in Hip Osteoarthritis Outcome Score pain, in Hip Osteoarthritis Outcome Score symptoms and Hip Osteoarthritis Outcome Score activities of daily living. After 24 months, no differences between the two surgical approaches were found. Of the 94 patients evaluated, the Trendelenburg test was positive in 31% of patients of which 81.9% corresponds to patients operated by the anterolateral approach. Muscle strength of the abductors of the operated hip was clearly lower in the anterolateral approach at six months, 12 months, and 24 months. This study showed that, in the first six months after total hip arthroplasty, the patients operated by the posterior approach were, according to the HOOS questionnaire, less symptomatic, and presented with better quality of life and less impact on activities of daily living and in sport and leisure when compared with the patients operated by the anterolateral approach. However, these differences were matched over the 24 months. Moreover, the results of muscle strength of the abductor muscles of the hip were clearly superior in
Wang, Fen; Liu, Li-Wei; Hu, Zhen; Peng, Yong; Zhang, Xiao-Qing; Li, Quan
BACKGROUND AND OBJECTIVES: Postoperative analgesia is crucial for early functional excise after total knee arthroplasty. To investigate the clinical efficacy of ultrasound and nerve stimulator guided continuous femoral nerve block analgesia after total knee arthroplasty. METHODS: 46 patients with ASA grade I-III who underwent total knee arthroplasty received ...
Mesfin, Addisu; Goddard, Maria S; Tuakli-Wosornu, Yetsa A; Khanuja, Harpal S
To the authors' knowledge, few reports have been published in the English literature of using total knee arthroplasty and total hip arthroplasty for the treatment of hereditary multiple exostoses. This article describes 2 patients with hereditary multiple exostoses, 1 treated with total hip arthroplasty and 1 treated with total knee arthroplasty. Bony deformities make arthroplasty uniquely challenging in patients undergoing total hip or knee arthroplasty. An expanded metaphysis of the proximal femur, coxa valga deformity, and the presence of hardware from previous reconstructive surgeries can make total hip arthroplasty technically difficult. Substantial bony deformity of the distal femur, valgus deformity of the knee, and sizing issues that necessitate custom implants can make total knee arthroplasty difficult. The most common bony deformities in hereditary multiple exostoses are short stature, limb-length discrepancy, valgus deformity at the knee and ankle, and asymmetry of the pectoral and pelvic girdles. Most reported surgical treatments for patients with hereditary multiple exostoses focus on the pediatric population or the management of malignant transformation of exostoses. Studies that specifically address the conditions associated with knee deformities focus on extra-articular deformity correction rather than arthroplasty.When arthroplasty is necessary in this patient population, an understanding of the commonly occurring deformities can help with preoperative planning and surgical management. All painful lesions must be evaluated for malignant transformation. Bone scans can be useful during workup. All specimens should be sent for pathologic evaluation. Such patients are challenging because of the distorted hip anatomy and valgus knee deformity. The current 2 cases illustrate specific challenges that can be anticipated and underscore key principles for arthroplasty in the management of hereditary multiple exostoses. Copyright 2012, SLACK Incorporated.
Ranzani José JT
Full Text Available Abstract Background This prospective experimental study evaluated the surgical procedure and results of modular hybrid total hip arthroplasty in dogs. Methods Ten skeletally mature healthy mongrel dogs with weights varying between 19 and 27 kg were used. Cemented modular femoral stems and uncemented porous-coated acetabular cups were employed. Clinical and radiographic evaluations were performed before surgery and at 30, 60, 90, 120, 180 and 360 days post-operation. Results Excellent weight bearing was noticed in the operated limb in seven dogs. Dislocation followed by loosening of the prosthesis was noticed in two dogs, which were therefore properly treated with a femoral head osteotomy. Femoral fracture occurred in one dog, which was promptly treated with full implant removal and femoral osteosynthesis. Conclusions The canine modular hybrid total hip arthroplasty provided excellent functionality of the operated limb.
Full Text Available Wear-related complications remain a major issue after unicompartmental arthroplasty. We used a computational model to predict knee wear generated in vitro under diverse conditions. Inverse finite element analysis of 2 different total knee arthroplasty designs was used to determine wear factors of standard and highly crosslinked polyethylene by matching predicted wear rates to measured wear rates. The computed wear factor was used to predict wear in unicompartmental components. The articular surface design and kinematic conditions of the unicompartmental and tricompartmental designs were different. Predicted wear rate (1.77 mg/million cycles was very close to experimental wear rate (1.84 mg/million cycles after testing in an AMTI knee wear simulator. Finite element analysis can predict experimental wear and may reduce the cost and time of preclinical testing.
Madadi, Firooz; Mehrvarz, Amir Sarshekeh; Madadi, Firoozeh; Boreiri, Majid; Abachizadeh, Kambiz; Ershadi, Ali
Suction drains provide an easy and feasible method for controlling hemorrhage after total knee arthroplasty. However, there has been no compromise regarding the optimum clamping time for these drains. We conducted a randomized clinical trial in 50 patients to compare 12-hour drain clamping and continuous drainage after total knee arthroplasty in terms of wound complications, blood loss, and articular arc of motion. To eliminate any other factor except duration of clamping, we chose to compare only knees belonging to a single patient and to restrict the study to those knees undergoing surgery due to osteoarthritis. From a total of 100 knees (50 patients) studied, the 12-hour-clamping method resulted in a significantly smaller amount of postoperative blood loss (p < 0.001). The passive ranges of motion and wound complications were not significantly different between the two groups.
Nadaud, Matthew C; Fehring, Thomas K; Fehring, Keith
Periprosthetic osteolysis in total knee arthroplasty (TKA) has become a significant problem. Routine surveillance is warranted to detect problems that may not be symptomatic. The goal of these radiographs is to detect arthroplasty-related bone loss at an early stage to implement strategies to limit its extension. The purpose of this study was to show the extent to which condylar osteolysis can be underestimated on routine radiographs. Two cadaveric femurs were prepared to receive a posterior stabilized (PS) femoral component. A simulated osteolytic lesion was created using acetabular reamers. Lesions of 36 mm not easily discernible on standard anteroposterior and lateral images were easily recognized on oblique films. The oblique radiographs described can help with the early recognition of retrofemoral osteolysis about a posterior-stabilized implant.
Harris, Ian A; Harris, Anita M; Naylor, Justine M; Adie, Sam; Mittal, Rajat; Dao, Alan T
We surveyed 331 patients undergoing total hip or knee arthroplasty pre-operatively, and patients and surgeons were both surveyed 6 and 12 months post-operatively. We identified variables (demographic factors, operative factors and patient expectations) as possible predictors for discordance in patient-surgeon satisfaction. At 12 months, 94.5% of surgeons and 90.3% of patients recorded satisfaction with the outcome. The discordance between patient and surgeon satisfaction was mainly due to patient dissatisfaction-surgeon satisfaction. In an adjusted analysis, the strongest predictors of discordance in patient-surgeon satisfaction were unmet patient expectations and the presence of complications. Advice to potential joint arthroplasty candidates regarding the decision to proceed with surgery should be informed by patient reported outcomes, rather than the surgeon's opinion of the likelihood of success. Copyright © 2013 Elsevier Inc. All rights reserved.
Nikolajsen, Lone; Brandsborg, Birgitte; Lucht, Ulf
BACKGROUND: Chronic post-operative pain is a well-recognized problem after various types of surgery, but little is known about chronic pain after orthopedic surgery. Severe pre-operative pain is the primary indication for total hip arthroplasty (THA). Therefore, we examined the prevalence...... of chronic pain after THA in relation to pre-operative pain and early post-operative pain. METHODS: A questionnaire was sent to 1231 consecutive patients who had undergone THA 12-18 months previously, and whose operations had been reported to the Danish Hip Arthroplasty Registry. RESULTS: The response rate...... was 93.6%. Two hundred and ninety-four patients (28.1%) had chronic ipsilateral hip pain at the time of completion of the questionnaire, and pain limited daily activities to a moderate, severe or very severe degree in 12.1%. The chronic pain state was related to the recalled intensity of early post...
The wear products and adverse reactions that occur on bearing surfaces represent one of the greatest challenges in prosthetic replacements, as the latter experience increasing demands due to the large number of young and older adult patients that have a long life expectancy and remarkable activity. The purpose of this review is to analyze the pros and cons of the new advances in the bearing components of the articular surfaces of current total hip arthroplasties. We also discuss the strategies used historically, their problems, results and the surgeon's role in prescribing the tribologic couple that best fits each patient's needs. We conclude with practical recommendations for the prescription and management of the latest articular couples for total hip arthroplasty.
da Silva, Robson Rocha; Santos, Ayrton André Melo; de Sampaio Carvalho Júnior, José; Matos, Marcos Almeida
To review the literature on quality of life among patients who underwent total knee arthroplasty (TKA) and assess the impact of various associated factors. this was a systematic review of the literature in the Medline, Embase, Lilacs and SciELO databases, using the terms: TKA (total knee arthroplasty); TKR (total knee replacement); quality of life; and outcomes. There were no restrictions regarding study design. 31 articles addressing this topic using various quality-of-life evaluation protocols were selected. SF-36/SF-12, WOMAC and Oxford were the ones most frequently used. The studies made it possible to define that TKA is capable of making an overall improvement in patients' quality of life. Pain and function are among the most important predictors of improvement in quality of life, even when function remains inferior to that of healthy patients. The factors associated negatively were obesity, advanced age, comorbidities, persistence of pain after the procedure and a lengthy wait for surgery.
Cooper, H John
Corrosion has long been recognized to occur in total hip arthroplasty, but the local effects of this process have only recently become better understood. This article provides an overview of corrosion at modular junctions, and discusses the various etiologic factors for corrosion and the biologic response to metal debris released from this junction. Algorithms are provided for diagnosis and treatment, in accordance with the best available data. Copyright © 2014 Elsevier Inc. All rights reserved.
Won Yong Shon
CONCLUSION: The sagittal position of pelvis is a key factor in impingement and dislocation after total hip arthroplasty. Pelvic tilting affects the position of acetabular component in the sagittal plane of the body as compared with its anatomic position in the pelvis. We suggest a preoperative lateral view of spine-pelvis, in upright and supine position for evaluation of a corrective adaptation of the acetabular cup accordingly with pelvic balance.
Periprosthetic bone resorbtion (osteolysis) and aseptic loosening constitute the major long-term complication in total hip arthroplasty. It has been suggested that osteolysis is the result of the action of osteoclasts generated by prosthetic wear-debris-triggered macrophages. In an electron-microscopic study of biopsies retrieved from periprosthetic osteolytic lesions, however, we were unable to show more osteoclasts than what would be expected in normal adult bone. Macropha...
Karataglis, D; Agathangelidis, F; Papadopoulos, P; Petsatodis, G; Christodoulou, A
Complications following unicompartmental knee arthroplasty (UKA) include aseptic loosening, polyethylene wear, arthritis progression and periprothetic fractures. We report on a patient with a firmly fixed, sizeable cement extrusion into the posteromedial aspect of the knee after a UKA causing impingement and pain in full extension. Cement extrusion is an extremely rare but potentially disabling complication that may occur despite care to remove all cement following implantation of the prosthe...
Hermes A.S. Kamimura
Full Text Available OBJECTIVES: This paper proposes imaging with 3-dimensional vibroacoustography for postoperatively assessing the uncovered cup area after total hip arthroplasty as a quantitative criterion to evaluate implant fixation. METHODS: A phantom with a bone-like structure covered by a tissue-mimicking material was used to simulate a total hip arthroplasty case. Vibroacoustography images of the uncovered cup region were generated using a two-element confocal ultrasound transducer and a hydrophone inside a water tank. Topological correction based on the geometry of the implant was performed to generate a 3-dimensional representation of the vibroacoustography image and to accurately evaluate the surface. The 3-dimensional area obtained by the vibroacoustography approach was compared to the area evaluated by a 3-dimensional motion capture system. RESULTS: The vibroacoustography technique provided high-resolution, high-contrast, and speckle-free images with less sensitivity to the beam incidence. Using a 3-dimensional-topology correction of the image, we accurately estimated the uncovered area of the implant with a relative error of 8.1% in comparison with the motion capture system measurements. CONCLUSION: Measurement of the cup coverage after total hip arthroplasty has not been well established; however, the covered surface area of the acetabular component is one of the most important prognostic factors. The preliminary results of this study show that vibroacoustography is a 3-dimensional approach that can be used to postoperatively evaluate total hip arthroplasty. The favorable results also provide an impetus for exploring vibroacoustography in other bone or implant surface imaging applications.
Background After the introduction of the Metasul system by Weber in 1988, total hip arthroplasty (THA) with metal-on-metal (MoM) bearings became increasingly popular in the 1990s. MoM bearings aimed to reduce the problem of aseptic loosening associated with polyethylene wear particles from conventional polyethylene cups. The following introduction of hip resurfacing added positive factors as bone sparing and large caliber heads, reducing the risk of dislocations. After alm...
Thomsen, Morten G; Husted, Henrik; Otte, Kristian Stahl
BACKGROUND: Little information exists to support that patients care about flexion beyond what is needed to perform activities of daily living (ADL) after Total knee arthroplasty (TKA). The purpose of this study was to investigate if the achievement of a higher degree of knee flexion after TKA wou...... -- as pain free ROM and high patient satisfaction were achieved with both TKA's.Trial registration: ClinicalTrials.gov: NCT00294528....
Ko, Gordon D; Bober, Sara L; Mindra, Sean; Moreau, Jason M
Cannabis has been widely used as a medicinal agent in Eastern medicine with earliest evidence in ancient Chinese practice dating back to 2700 BC. Over time, the use of medical cannabis has been increasingly adopted by Western medicine and is thus a rapidly emerging field that all pain physicians need to be aware of. Several randomized controlled trials have shown a significant and dose-dependent relationship between neuropathic pain relief and tetrahydrocannabinol - the principal psychoactive component of cannabis. Despite this, barriers exist to use from both the patient perspective (cost, addiction, social stigma, lack of understanding regarding safe administration) and the physician perspective (credibility, criminality, clinical evidence, patient addiction, and policy from the governing medical colleges). This review addresses these barriers and draws attention to key concerns in the Canadian medical system, providing updated treatment approaches to help clinicians work with their patients in achieving adequate pain control, reduced narcotic medication use, and enhanced quality of life. This review also includes case studies demonstrating the use of medical marijuana by patients with neuropathic low-back pain, neuropathic pain in fibromyalgia, and neuropathic pain in multiple sclerosis. While significant preclinical data have demonstrated the potential therapeutic benefits of cannabis for treating pain in osteoarthritis, rheumatoid arthritis, fibromyalgia, and cancer, further studies are needed with randomized controlled trials and larger study populations to identify the specific strains and concentrations that will work best with selected cohorts.
Díaz-Heredia, J; Loza, E; Cebreiro, I; Ruiz Iban, M Á
To analyze the efficacy and safety of preventive analgesia in patients undergoing hip or knee arthroplasty due to osteoarthritis. A systematic literature review was performed, using a defined a sensitive strategy on Medline, Embase and Cochrane Library up to May 2013. The inclusion criteria were: patients undergoing knee and/or hip arthroplasty, adults with moderate or severe pain (≥4 on a Visual Analog Scale). The intervention, the use (efficacy and safety) of pharmacological treatment (preventive) close to surgery was recorded. Oral, topical and skin patch drugs were included. Systematic reviews, meta-analysis, controlled trials and observational studies were selected. A total of 36 articles, of moderate quality, were selected. The patients included were representative of those undergoing knee and/or hip arthroplasty in Spain. They had a mean age >50 years, higher number of women, and reporting moderate to severe pain (≥4 on a Visual Analog Scale). Possurgical pain was mainly evaluated with a Visual Analog Scale. A wide variation was found as regards the drugs used in the preventive protocols, including acetaminophen, classic NSAID, Cox-2, opioids, corticosteroids, antidepressants, analgesics for neuropathic pain, as well as others, such as magnesium, ketamine, nimodipine or clonidine. In general, all of them decreased post-surgical pain without severe adverse events. The use or one or more pre-surgical analgesics decreases the use of post-surgical drugs, at least for short term pain. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.
Sánchez Mayo, B; Rodríguez-Mansilla, J; González Sánchez, B
The purpose of this study was to know the effects of continuous passive mobilization in patients who underwent total knee arthroplasty. A search strategy was developed to retrieve all clinical trials, written in English and/or Spanish, published in the electronic search databases PubMed, Cochrane Library Plus, Dialnet, CSIC and PEDro. The inclusion criteria were: clinical trials published from January 2000 until November 2014 in English or Spanish. Out of 537 clinical trials that were potentially relevant, a total of 12 were included in this review. The evaluation of 1,153 patients shows that there is no significant difference in improving the range of the joint, pain, balance, motion, healing and hospital stay using continuous passive mobilization against the regular physiotherapy treatment for total knee arthroplasty. The application of continuous passive mobilization in the long-term does not provide any benefit in terms of the breadth of the range of the joint, pain and improvement of standing and motion in comparison with conventional postoperative physiotherapy treatment in total knee arthroplasty. In the short term an improvement is obtained in the range of joint motion in knee flexion.
Saleh, Khaled J; Lee, Laura W; Gandhi, Rajiv; Ingersoll, Christopher D; Mahomed, Nizar N; Sheibani-Rad, Shahin; Novicoff, Wendy M; Mihalko, William M
After total knee arthroplasty, quadriceps femoris muscle strength is an important determinant of physical function. Quadriceps weakness is often present in the osteoarthritic limb and worsens after total knee arthroplasty. Although some quadriceps strength is regained, it may take more than 2 years to achieve preoperative levels, and it is unclear if quadriceps strength in the operated limb ever reaches that of the nondiseased contralateral limb or the quadriceps strength of healthy controls. Studies point to volitional muscle activation rather than muscle atrophy or joint pain as the cause of the weakness. The unresolved challenge lies in clarifying the optimal surgical and rehabilitation course that will reverse the weakness early or prevent its occurrence. Studies suggest that progressive resistive strengthening exercises and neuromuscular electrical stimulation, possibly along with "prehabilitation," improve quadriceps volitional force output. Well-designed, controlled studies are necessary to determine efficacy. Because knee osteoarthritis and total knee arthroplasty are highly prevalent, improving quadriceps weakness is an important goal for orthopaedic surgeons and rehabilitation specialists.
In this article, I have used the 2004 Greatest Canadian contest as an example of media's educational function. Contrary to mainstream discourse of gender-neutral citizenship, this contest reiterates a notion of Canadian citizenship as masculinized, classed, and raced. Gramsci's concepts of "hegemony," "ideology", and…
Duchman, Kyle R; Pugely, Andrew J; Martin, Christopher T; Gao, Yubo; Bedard, Nicholas A; Callaghan, John J
Increased operative time has been associated with increased complications after total joint arthroplasty (TJA). The purpose of the present study was to investigate the effect of operative time on short-term complications after TJA while also identifying patient and operative factors associated with prolonged operative times. The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2011-2013 to identify all patients who underwent primary total hip or knee arthroplasty. Patients were stratified by operative time, and 30-day morbidity and mortality data compared using univariate and multivariable analyses. We identified 99,444 patients who underwent primary TJA. The overall incidence of complications after TJA was 4.9%. Overall complications were increased in patients with operative times >120 minutes (5.9%) as compared to patients with operative times 120 minutes. In a multivariable analysis, operative time exceeding 120 minutes remained an independent predictor of any complication and wound complication, with each 30-minute increase in operative time beyond 120 minutes further increasing risk. Patient age ≤65 years, male sex, black race, body mass index ≥30 kg/m2, and an American Society of Anesthesiologists classification of 3 or 4, predicted operative times >120 minutes. We found that operative time >120 minutes was associated with increased short-term morbidity and mortality after primary TJA. Younger age, male sex, black race, obesity, and increased comorbidity were risk factors for operative time exceeding 120 minutes. Copyright © 2016 Elsevier Inc. All rights reserved.
Zusmanovich, Mikhail; Kester, Benjamin S; Schwarzkopf, Ran
High body mass index (BMI) is associated with significant complications in patients undergoing total joint arthroplasty. Many studies have evaluated this trend, but few have looked at the rates of complications based on BMI as a continuous variable. The purpose of this study was to stratify obese patients into 3 BMI categories and evaluate their rates of complications and gauge whether transitioning from higher to lower BMI category lowers complication. Patients undergoing primary total joint arthroplasty were selected from the National Surgical Quality Improvement Program database from 2008-2015 and arranged into 3 groups based on BMI: O1 (BMI 30-34.9 kg/m(2)), O2 (BMI 35-39.9 kg/m(2)), and O3 (BMI >40 kg/m(2)). Thirty-day complications were recorded and evaluated utilizing univariate and multivariate analyses stratified by BMI. A total of 268,663 patients were identified. Patients with a BMI >30 kg/m(2) had more infectious and medical complications compared with nonobese patients. Furthermore, there were increased complications as the BMI categories increased. Patients with a BMI >40 kg/m(2) (O3) had longer operating times, length of stay, higher rates of readmissions, reoperations, deep venous thrombosis, renal insufficiency, superficial infections, deep infections, and wound dehiscence. These trends were present when comparing the O2 with O1 category as well. We have demonstrated increased rates of medical and surgical complications in obese patients. Furthermore, we demonstrated a stepwise increase in complication rates when transitioning to higher BMI groups. Based on our data, we believe that preoperative counseling and interventions to decrease BMI should be explored before offering elective surgery to obese patients. Copyright © 2017 Elsevier Inc. All rights reserved.
Pohl, Torsten; Brauner, Torsten; Wearing, Scott; Stamer, Knut; Horstmann, Thomas
Sensorimotor function is degraded in patients after lower limb arthroplasty. Sensorimotor training is thought to improve sensorimotor skills, however, the optimal training stimulus with regard to volume, frequency, duration, and intensity is still unknown. The aim of this study, therefore, was to firstly quantify the progression of sensorimotor function after total hip (THA) or knee (TKA) arthroplasty and, as second step, to evaluate effects of different sensorimotor training volumes. 58 in-patients during their rehabilitation after THA or TKA participated in this prospective cohort study. Sensorimotor function was assessed using a test battery including measures of stabilization capacity, static balance, proprioception, and gait, along with a self-reported pain and function. All participants were randomly assigned to one of three intervention groups performing sensorimotor training two, four, or six times per week. Outcome measures were taken at three instances, at baseline (pre), after 1.5 weeks (mid) and at the conclusion of the 3 week program (post). All measurements showed significant improvements over time, with the exception of proprioception and static balance during quiet bipedal stance which showed no significant main effects for time or intervention. There was no significant effect of sensorimotor training volume on any of the outcome measures. We were able to quantify improvements in measures of dynamic, but not static, sensorimotor function during the initial three weeks of rehabilitation following TKA/THA. Although sensorimotor improvements were independent of the training volume applied in the current study, long-term effects of sensorimotor training volume need to be investigated to optimize training stimulus recommendations. Clinical trial registration number: DRKS00007894.
Ondeck, Nathaniel T; Fu, Michael C; Skrip, Laura A; McLynn, Ryan P; Su, Edwin P; Grauer, Jonathan N
Despite the advantages of large, national datasets, one continuing concern is missing data values. Complete case analysis, where only cases with complete data are analyzed, is commonly used rather than more statistically rigorous approaches such as multiple imputation. This study characterizes the potential selection bias introduced using complete case analysis and compares the results of common regressions using both techniques following unicompartmental knee arthroplasty. Patients undergoing unicompartmental knee arthroplasty were extracted from the 2005 to 2015 National Surgical Quality Improvement Program. As examples, the demographics of patients with and without missing preoperative albumin and hematocrit values were compared. Missing data were then treated with both complete case analysis and multiple imputation (an approach that reproduces the variation and associations that would have been present in a full dataset) and the conclusions of common regressions for adverse outcomes were compared. A total of 6117 patients were included, of which 56.7% were missing at least one value. Younger, female, and healthier patients were more likely to have missing preoperative albumin and hematocrit values. The use of complete case analysis removed 3467 patients from the study in comparison with multiple imputation which included all 6117 patients. The 2 methods of handling missing values led to differing associations of low preoperative laboratory values with commonly studied adverse outcomes. The use of complete case analysis can introduce selection bias and may lead to different conclusions in comparison with the statistically rigorous multiple imputation approach. Joint surgeons should consider the methods of handling missing values when interpreting arthroplasty research. Copyright © 2017 Elsevier Inc. All rights reserved.
Husted, Henrik; Holm, Gitte
This study investigated whether unselected patients operated on with total hip arthroplasty (THA) or total knee arthroplasty (TKA) could accomplish a self-developed accelerated track, ANORAK-HH, with a planned length of stay (LOS) of maximum 5 days and patient satisfaction at all parts of the tra...
Husted, Henrik; Holm, Gitte
This study investigated whether unselected patients operated on with total hip arthroplasty (THA) or total knee arthroplasty (TKA) could accomplish a self-developed accelerated track, ANORAK-HH, with a planned length of stay (LOS) of maximum 5 days and patient satisfaction at all parts of the track...
Reininga, Inge H. F.; Stevens, Martin; Wagenmakers, Robert; Bulstra, Sjoerd K.; van den Akker-Scheek, Inge
Total hip arthroplasty and total knee arthroplasty have proven to be effective surgical procedures for the treatment of hip and knee osteoarthritis. In recent decades, there have been considerable efforts to improve the component designs, modes of fixation, and surgical techniques. Minimally
Gundtoft, P H; Pedersen, Alma Becic; Schønheyder, H C
AIMS: The purpose of this study was to validate the diagnosis of periprosthetic joint infection (PJI) in the Danish Hip Arthroplasty Register (DHR). PATIENTS AND METHODS: We identified a cohort of patients from the DHR who had undergone primary total hip arthroplasty (THA) since 1 January 2005 an...
Deleuran, Thomas; Vilstrup, Hendrik; Overgaard, Søren
Background and purpose: The risk of complications in cirrhosis patients after orthopedic surgery is unclear. We examined this risk after total hip arthroplasty (THA) or total knee arthroplasty (TKA). Patients and methods: Using Danish healthcare registries, we identified all Danish residents who...
Jæger, Pia; Koscielniak-Nielsen, Zbigniew J; Schrøder, Henrik M
BACKGROUND: Revision knee arthroplasty is assumed to be even more painful than primary knee arthroplasty and predominantly performed in chronic pain patients, which challenges postoperative pain treatment. We hypothesized that the adductor canal block, effective for pain relief after primary tota...
Holm, Bente; Kristensen, Morten T; Bencke, Jesper
To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA).......To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA)....
Background. Resource-intensive procedures require the use of patient waiting lists in an attempt to increase fairness of access to surgery and improve surgical efficiency. Total hip and knee arthroplasty has waiting lists in excess of years. Objectives. To analyse our tertiary state institution's hip and knee arthroplasty waiting ...
Full Text Available Introduction Isolated patellofemoral (PF arthritis is rare, and there is no complete agreement about the best surgical treatment. The operative treatments are total knee arthroplasty and patellofemoral replacement (PFR. The incidence of many early complications of PF arthroplasty has decreased with the introduction of newer designs. Nowadays, the main cause of revision surgery is the progression of tibiofemoral osteoarthritis. In the past, PF arthroplasty was contraindicated in patients with evidence of osteoarthritis or pain in medial or lateral tibiofemoral compartments. The improvement in implant designs and surgical techniques has allowed the addition of a monocompartmental arthroplasty for the medial or lateral tibiofemoral compartment. In this work, we evaluate our first experience with PF arthroplasty and its combination with unicompartmental knee arthroplasty. Materials and Methods From May 2014 to March 2016, we treated 14 patients. An isolated PF arthroplasty was performed in six knees (five patients, and a combined PF and unicompartmental knee arthroplasty was performed in nine cases. We observed a significant improvement in the clinical and functional Knee Society Scores (KSSs after surgery in our patients. Results We obtained good results in our cases both for clinical and functional KSSs. Patellar clunk was recorded in one case. Discussion and Conclusion We are going toward a new attitude in which partial osteoarthritic changes could be treated with partial resurfacing prosthetic solutions such as unicompartmental, bi–unicompartmental or PFR alone, or unicompartmental combined, which respects the cruciates and achieves maximal bone preservation, which is vital, particularly, for young patients.
Gee, Marianne E; Bienek, Asako; McAlister, Finlay A; Robitaille, Cynthia; Joffres, Michel; Tremblay, Mark S; Johansen, Helen; Campbell, Norm R C
Approximately 17% of Canadians with high blood pressure were unaware of their condition, and of Canadians aware of having the condition, approximately 1 in 5 have uncontrolled high blood pressure despite high rates of pharmacotherapy. The objectives of the current study are to estimate the prevalence of resistant hypertension and examine factors associated with (1) lack of awareness and (2) uncontrolled hypertension despite pharmacotherapy. Using the 2007-2009 Canadian Health Measures Survey (N = 3473, aged 20-79 years) and logistic regression, we quantified relationships between characteristics and (1) presence of hypertension, (2) lack of awareness (among those with hypertension), and (3) uncontrolled high blood pressure (among those treated for hypertension). Older age, lowest income, and less than high school education were associated with presence of hypertension. Men (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2) and adults high blood pressure (OR, 2.4; 95% CI, 1.1-5.2) despite treatment. Elevated systolic blood pressure was the issue in over 90% of women and 80% of men with uncontrolled hypertension. Depending on the definition employed, 4.4% (95% CI, 2.4-6.4) to 7.8% (95% CI, 6.0-9.6) of the population with hypertension had resistant hypertension. Messaging or interventions encouraging screening may be helpful for all younger Canadian adults and men; programs encouraging blood pressure control may help older women. Copyright © 2012 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
McAlpine, Kristen; Steele, Stephen
The urogenital physical examination is an important aspect of patient encounters in various clinical settings. Introductory clinical skills sessions are intended to provide support and alleviate students' anxiety when learning this sensitive exam. The techniques each Canadian medical school uses to guide their students through the initial urogenital examination has not been previously reported. This study surveyed pre-clerkship clinical skills program directors at the main campus of English-speaking Canadian medical schools regarding the curriculum they use to teach the urogenital examination. A response rate of 100% was achieved, providing information on resources and faculty available to students, as well as the manner in which students were evaluated. Surprisingly, over one-third of the Canadian medical schools surveyed failed to provide a setting in which students perform a urogenital examination on a patient in their pre-clinical years. Additionally, there was no formal evaluation of this skill set reported by almost 50% of Canadian medical schools prior to clinical training years. To ensure medical students are confident and accurate in performing a urogenital examination, it is vital they be provided the proper resources, teaching, and training. As we progress towards a competency-based curriculum, it is essential that increased focus be placed on patient encounters in undergraduate training. Further research to quantify students' exposure to the urogenital examination during clinical years would be of interest. Without this commitment by Canadian medical schools, we are doing a disservice not only to the medical students, but also to our patient population.
Objective To provide a clinical summary of the Canadian clinical practice guidelines for acute bacterial rhinosinusitis (ABRS) that includes relevant considerations for family physicians. Quality of evidence Guideline authors performed a systematic literature search and drafted recommendations. Recommendations received both strength of evidence and strength of recommendation ratings. Input from external content experts was sought, as was endorsement from Canadian medical societies (Association of Medical Microbiology and Infectious Disease Canada, Canadian Society of Allergy and Clinical Immunology, Canadian Society of Otolaryngology—Head and Neck Surgery, Canadian Association of Emergency Physicians, and the Family Physicians Airways Group of Canada). Main message Diagnosis of ABRS is based on the presence of specific symptoms and their duration; imaging or culture are not needed in uncomplicated cases. Treatment is dependent on symptom severity, with intranasal corticosteroids (INCSs) recommended as monotherapy for mild and moderate cases, although the benefit might be modest. Use of INCSs plus antibiotics is reserved for patients who fail to respond to INCSs after 72 hours, and for initial treatment of patients with severe symptoms. Antibiotic selection must account for the suspected pathogen, the risk of resistance, comorbid conditions, and local antimicrobial resistance trends. Adjunct therapies such as nasal saline irrigation are recommended. Failure to respond to treatment, recurrent episodes, and signs of complications should prompt referral to an otolaryngologist. The guidelines address situations unique to the Canadian health care environment, including actions to take during prolonged wait periods for specialist referral or imaging. Conclusion The Canadian guidelines provide up-to-date recommendations for diagnosis and treatment of ABRS that reflect an evolving understanding of the disease. In addition, the guidelines offer useful tools to help
Smith, Timothy R; Hulou, M Maher; Yan, Sandra C; Cote, David J; Nahed, Brian V; Babu, Maya A; Das, Sunit; Gormley, William B; Rutka, James T; Laws, Edward R; Heary, Robert F
OBJECT Recent studies have examined the impact of perceived medicolegal risk and compared how this perception impacts defensive practices within the US. To date, there have been no published data on the practice of defensive medicine among neurosurgeons in Canada. METHODS An online survey containing 44 questions was sent to 170 Canadian neurosurgeons and used to measure Canadian neurosurgeons' perception of liability risk and their practice of defensive medicine. The survey included questions on the following domains: surgeon demographics, patient characteristics, type of physician practice, surgeon liability profile, policy coverage, defensive behaviors, and perception of the liability environment. Survey responses were analyzed and summarized using counts and percentages. RESULTS A total of 75 neurosurgeons completed the survey, achieving an overall response rate of 44.1%. Over one-third (36.5%) of Canadian neurosurgeons paid less than $5000 for insurance annually. The majority (87%) of Canadian neurosurgeons felt confident with their insurance coverage, and 60% reported that they rarely felt the need to practice defensive medicine. The majority of the respondents reported that the perceived medicolegal risk environment has no bearing on their preferred practice location. Only 1 in 5 respondent Canadian neurosurgeons (21.8%) reported viewing patients as a potential lawsuit. Only 4.9% of respondents would have selected a different career based on current medicolegal risk factors, and only 4.1% view the cost of annual malpractice insurance as a major burden. CONCLUSIONS Canadian neurosurgeons perceive their medicolegal risk environment as more favorable and their patients as less likely to sue than their counterparts in the US do. Overall, Canadian neurosurgeons engage in fewer defensive medical behaviors than previously reported in the US.
Full Text Available Most diversity management programs in Canada maintain that enhancing workforce diversity is of tremendous significance for business organizations in today’s competitive global urban markets. Since well-meaning diversity management initiatives have been largely ineffective thus far in dealing with workplace discrimination and racism in the Canadian workplace, this paper underscores the need to decenter the focus of diversity management from a business imperative to an antidiscrimination and social justice imperative. Within this latter perspective, the paper examines the strengths and limitations of the antiracism approach that has been implemented in various developed countries in recent years. The antiracism approach is an action-oriented strategy for institutional and systemic change that has at its core the interrogation of privilege, power disparities, and other forms of inequity within the organization. Drawing from the lessons of various initiatives that have utilized this approach, the present paper emphasizes the need for a nuanced antiracism approach in the multicultural Canadian society if diversity management is to attain its goal of greater inclusion of all individuals in informal networks and formal organizational programs.
Sundseth, Jarle; Jacobsen, Eva Astrid; Kolstad, Frode; Sletteberg, Ruth O.; Nygaard, Oystein P.; Johnsen, Lars Gunnar; Pripp, Are Hugo; Andresen, Hege; Fredriksli, Oddrun Anita; Myrseth, Erling; Zwart, John A.
Purpose Heterotopic ossification is a phenomenon in cervical arthroplasty. Previous reports have mainly focused on various semiconstrained devices and only a few publications have focused on ossification around devices that are nonconstrained. The purpose of this study was to assess the occurrence of heterotopic ossification around a nonconstrained cervical device and how it affects clinical outcome 2 years after surgery. Methods Thirty-seven patients were included from a larger cohort of ...
Bashinskaya, Bronislava; Zimmerman, Ryan M; Walcott, Brian P; Antoci, Valentin
Osteoarthritis is a common indication for hip and knee arthroplasty. An accurate assessment of current trends in healthcare utilization as they relate to arthroplasty may predict the needs of a growing elderly population in the United States. First, incidence data was queried from the United States Nationwide Inpatient Sample from 1993 to 2009. Patients undergoing total knee and hip arthroplasty were identified. Then, the United States Census Bureau was queried for population data from the same study period as well as to provide future projections. Arthroplasty followed linear regression models with the population group >64 years in both hip and knee groups. Projections for procedure incidence in the year 2050 based on these models were calculated to be 1,859,553 cases (hip) and 4,174,554 cases (knee). The need for hip and knee arthroplasty is expected to grow significantly in the upcoming years, given population growth predictions.
Naal, Florian D; Fischer, Michael; Preuss, Alexander; Goldhahn, Joerg; von Knoch, Fabian; Preiss, Stefan; Munzinger, Urs; Drobny, Tomas
There is a lack of detailed information concerning patients' sports and recreational activities after unicompartmental knee arthroplasty. Patients treated by unicompartmental knee arthroplasty will be able to return to sports and activity. Case series; Level of evidence, 4. The authors surveyed 83 patients by postal questionnaires to determine their sporting and recreational activities at a mean follow-up of 18 +/- 4.6 months (range, 12-28) after unicompartmental knee arthroplasty. For data analysis, patients were divided into groups of women and men, and older and younger patients (those above and below the median age of the group). The authors also assessed the state of general health (SF-36) of the patients at the time of the survey and compared the results with those of a matched (for age and side-diagnoses) reference population. Before surgery, 77 of 83 patients were engaged in an average of 5.0 sports and recreational disciplines; postoperatively, 73 (88%) participated in an average of 3.1 different sports disciplines, resulting in a return to activity rate of 95%. The frequency of activities (sessions per week) was 2.9 preoperatively and remained constant at the time of survey (2.8). The group of older patients (mean age 73.0 y) revealed a significantly higher frequency than the group of younger patients (mean age 57.8 y). The minimum session length decreased from 66 minutes before surgery to 55 minutes after surgery. The most common activities after surgery were hiking, cycling, and swimming. Several high-impact activities, as well as the winter disciplines of downhill- and cross-country skiing had a significant decrease in participating patients. The majority of the patients (90.3%) stated that surgery had maintained or improved their ability to participate in sports or recreational activities. The patients generally scored very high on the SF-36 compared with the matched reference population. Higher SF-36 values in the physical-related domains correlated
Van der Linden-Van der Zwaag Henrica MJ
Full Text Available Abstract Background In the light of both the importance and large numbers of case series and cohort studies (observational studies in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality. A Delphi approach was used to develop a checklist for reporting quality, methodological quality and generalizability of case series and cohorts in total hip and total knee arthroplasty with a focus on aseptic loosening. Methods A web-based Delphi was conducted consisting of two internal rounds and three external rounds in order to achieve expert consensus on items considered relevant for reporting quality, methodological quality and generalizability. Results The internal rounds were used to construct a master list. The first external round was completed by 44 experts, 35 of them completed the second external round and 33 of them completed the third external round. Consensus was reached on an 8-item reporting quality checklist, a 6-item methodological checklist and a 22-item generalizability checklist. Conclusions Checklist for reporting quality, methodological quality and generalizability for case series and cohorts in total hip and total knee arthroplasty were successfully created through this Delphi. These checklists should improve the accuracy, completeness and quality of case series and cohorts regarding total hip and total knee arthroplasty.
Pijls, Bart G; Dekkers, Olaf M; Middeldorp, Saskia; Valstar, Edward R; van der Heide, Huub J L; Van der Linden-Van der Zwaag, Henrica M J; Nelissen, Rob G H H
In the light of both the importance and large numbers of case series and cohort studies (observational studies) in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality. A Delphi approach was used to develop a checklist for reporting quality, methodological quality and generalizability of case series and cohorts in total hip and total knee arthroplasty with a focus on aseptic loosening. A web-based Delphi was conducted consisting of two internal rounds and three external rounds in order to achieve expert consensus on items considered relevant for reporting quality, methodological quality and generalizability. The internal rounds were used to construct a master list. The first external round was completed by 44 experts, 35 of them completed the second external round and 33 of them completed the third external round. Consensus was reached on an 8-item reporting quality checklist, a 6-item methodological checklist and a 22-item generalizability checklist. Checklist for reporting quality, methodological quality and generalizability for case series and cohorts in total hip and total knee arthroplasty were successfully created through this Delphi. These checklists should improve the accuracy, completeness and quality of case series and cohorts regarding total hip and total knee arthroplasty.
This article reports on a study of student experiences of a Walls to Bridges (W2B) class taught by Faculty of Social Work instructors in a Canadian women's prison. The Walls to Bridges (W2B) program is based on the U. S. Inside-Out Prison Exchange Program and brings students from the university together with students from the prison to study for a…
Humphries, Serena; Hampe, Tanis; Larsen, Derrick; Bowen, Sarah
The use of evidence to inform decisions at the program level within healthcare organizations is a priority. The purpose of this article is to provide an overview of an innovative collaboration between two Canadian healthcare organizations to build organizational capacity for evidence use in program planning, implementation, and evaluation. The lessons learned from the initiative suggest that other healthcare organizations would find the capacity-building strategies identified and developed through the initiative useful.
Dicks, Kristen V.; Baker, Arthur W.; Durkin, Michael J.; Anderson, Deverick J.; Moehring, Rebekah W.; Chen, Luke F.; Sexton, Daniel J.; Weber, David J.; Lewis, Sarah S.
OBJECTIVE To determine the association (1) between shorter operative duration and surgical site infection (SSI) and (2) between surgeon median operative duration and SSI risk among first-time hip and knee arthroplasties. DESIGN Retrospective cohort study SETTING A total of 43 community hospitals located in the southeastern United States. PATIENTS Adults who developed SSIs according to National Healthcare Safety Network criteria within 365 days of first-time knee or hip arthroplasties performed between January 1, 2008 and December 31, 2012. METHODS Log-binomial regression models estimated the association (1) between operative duration and SSI outcome and (2) between surgeon median operative duration and SSI outcome. Hip and knee arthroplasties were evaluated in separate models. Each model was adjusted for American Society of Anesthesiology score and patient age. RESULTS A total of 25,531 hip arthroplasties and 42,187 knee arthroplasties were included in the study. The risk of SSI in knee arthroplasties with an operative duration shorter than the 25th percentile was 0.40 times the risk of SSI in knee arthroplasties with an operative duration between the 25th and 75th percentile (risk ratio [RR], 0.40; 95% confidence interval [CI], 0.38–0.56; P operative duration did not demonstrate significant association with SSI for hip arthroplasties (RR, 1.04; 95% CI, 0.79–1.37; P =.36). Knee arthroplasty surgeons with shorter median operative durations had a lower risk of SSI than surgeons with typical median operative durations (RR, 0.52; 95% CI, 0.43–0.64; P operative durations were not associated with a higher SSI risk for knee or hip arthroplasty procedures in our analysis. PMID:26391277
Easson, Amanda; Agarwal, Arnav; Duda, Stephanie; Bennett, Kathryn
Responsible media reporting of youth suicide may reduce the risk of contagion and increase help-seeking behaviour. Accordingly, we conducted a content analysis of Canadian youth suicide newspaper articles to assess quality and summarize content (themes, age groups, populations and use of scientific evidence). The Canadian Periodical Index Quarterly (CPI.Q) was searched (2008-2012) for full-text Canadian newspaper articles using the keywords "youth" and "suicide." The top five most relevant articles as judged by CPI.Q were selected sequentially for each year (n=25). Quality was assessed using World Health Organization (WHO) guidelines for responsible media reporting. Content analysis was completed in duplicate by two reviewers. All articles addressed youth suicide generally rather than reporting exclusively on a specific death by suicide. Alignment of articles with individual WHO guideline items ranged from 16 to 60%. The most common content theme was prevention (80%). No article was judged to glamorize suicide. Help seeking was addressed in 52% of articles, but only 20% provided information on where to obtain help. Statistics were referenced more frequently than scientific research (76% vs. 28%). Our review suggests that Canadian media presents youth suicide as an issue for which hope and help exist. While the majority of reports aim to educate the public about suicide, increased use of scientific evidence about risk factors and prevention is recommended to facilitate the translation of rigorous scientific knowledge into improved mental health and reduced suicide risk among Canadian youth.
the Telage Researchers
Full Text Available This study aimed at exploring patients’ perceptions regarding telerehabilitation services received post total knee replacement. In this qualitative embedded single case study, semi-structured interviews were conducted with five patients who had previously received in-home telerehabilitation post total knee arthroplasty. Participants were asked to reflect on their 8-week rehabilitation process and on their experience with the home telerehabilitation program. Interviews were transcribed and a qualitative thematic analysis was conducted. Six overarching themes emerged from the patients’ perceptions: (1 improving access to services with reduced need for transportation; (2 developing a strong therapeutic relationship with therapist while maintaining a sense of personal space; (3 complementing telerehabilitation with in-person visits; (4 providing standardized yet tailored and challenging exercise programs using telerehabilitation; (5 perceived ease-of-use of telerehabilitation equipment; and (6 feeling an ongoing sense of support. Gaining a better understating of the patient’s experience in telerehabilitation will be essential as programs continue to be developed and implemented.
Morton, Heather; Gorzalka, Boris B
The purpose of this study was to investigate the sexual beliefs of female undergraduates, as well as the thoughts they experience during sexual experiences. The study aimed to determine potential differences in these variables between East Asian-Canadians and Euro-Canadians, as well as the influence of acculturation on these variables. In addition, the relationships between sexual beliefs, automatic thoughts, and specific aspects of sexual functioning were examined. Euro-Canadian (n = 77) and East Asian-Canadian (n = 123) undergraduate women completed the Sexual Dysfunctional Beliefs Questionnaire, the Sexual Modes Questionnaire, the Female Sexual Function Index, and the Vancouver Index of Acculturation. East Asian women endorsed almost all sexual beliefs assessed in this study more than did Euro-Canadian women, and endorsement of these beliefs was associated with acculturation. In addition, East Asian-Canadian and Euro-Canadian women differed in the frequency of experiencing negative automatic thoughts. Results also revealed associations between difficulties in sexual functioning, and both sexual beliefs and automatic thoughts. Together, these results provide preliminary support for the hypothesis that differences in cognitive aspects of sexuality may underlie the differences in sexual functioning previously observed between these two groups.
Brownbridge, Michael; Buitenhuis, Rose
Historically, greenhouse floriculture has relied on synthetic insecticides to meet its pest control needs. But, growers are increasingly faced with the loss or failure of synthetic chemical pesticides, declining access to new chemistries, stricter environmental/health and safety regulations, and the need to produce plants in a manner that meets the 'sustainability' demands of a consumer driven market. In Canada, reports of thrips resistance to spinosad (Success™) within 6-12 months of its registration prompted a radical change in pest management philosophy and approach. Faced with a lack of registered chemical alternatives, growers turned to biological control out of necessity. Biological control now forms the foundation for pest management programs in Canadian floriculture greenhouses. Success in a biocontrol program is rarely achieved through the use of a single agent, though. Rather, it is realized through the concurrent use of biological, cultural and other strategies within an integrated plant production system. Microbial insecticides can play a critical supporting role in biologically-based integrated pest management (IPM) programs. They have unique modes of action and are active against a range of challenging pests. As commercial microbial insecticides have come to market, research to generate efficacy data has assisted their registration in Canada, and the development and adaptation of integrated programs has promoted uptake by floriculture growers. This review documents some of the work done to integrate microbial insecticides into chrysanthemum and poinsettia production systems, outlines current use practices, and identifies opportunities to improve efficacy in Canadian floriculture crops. Copyright © 2017 Elsevier Inc. All rights reserved.
Lau, Timothy; Zamani, Delara; Lee, Elliott Kyung; Asli, Khashayar D; Gill, Jasbir; Brager, Nancy; Hawa, Raed; Song, Wei-Yi; Gill, Eunice; Fitzpatrick, Renee; Menezes, Natasja M; Pham, Vu H; Douglass, Alan Bruce; Allain, Suzanne; Meterissian, Greg B; Gagnon, Nadine; Toeg, Hadi; Murphy, Cheryl
There is a projected shortage of psychiatrists in Canada in forthcoming years. This study assessed factors in medical school education that are associated with students selecting psychiatry first and matching as a discipline. The Canadian Organization of Undergraduate Psychiatry Educators (COUPE) conducted telephone interviews and sent e-mail questionnaires to the 17 medical schools across Canada; all schools provided data for 2012. Relevant data were obtained from the Canadian Resident Matching Service. Statistics were performed using v12 STATA program, and significance was set at a p value of psychiatry as their first choice for residency. Final match results yielded similar numbers at 5.0 ± 0.6 %. Ten out of 17 programs filled all psychiatry residency positions, whereas the remaining 7 programs had vacancy rates from 5 to 100 % (mean = 43.4 ± 15.1 %). Medical students were exposed to an average of 2.8 ± 0.5 pre-clerkship psychiatry weeks and 6.2 ± 0.3 clerkship weeks. Linear regression analysis demonstrated that the percentage of graduating medical students entering a psychiatry residency program could be predicted from the number of weeks of pre-clerkship exposure (p = 0.01; R(2) = 0.36) but not from the number of clerkship weeks (p = 0.74). This study indicates that the duration of pre-clerkship exposure to psychiatry predicts the number of students selecting psychiatry as their first choice as a discipline. Thus, increasing the duration of pre-clerkship exposure may increase the enrollment of medical students into psychiatry.