Variations and inequities in access to cardiac diagnostic services in Ontario Canada.

Objectives: Echocardiography is an essential diagnostic modality known to have wide regional utilization variations. This study's objectives were to quantify regional variations and to examine the extent to which they are explained by differences in population age, sex, cardiac disease prevalence (CDP), and social determinants of health (SDH) risk.

Methods: This is an observational study of all echocardiography exams performed in Ontario in 2019/20 (n = 695,622).

Chest Pain Evaluation: Diagnostic Testing.

Chest pain/discomfort (CP) is a common symptom and can be a diagnostic dilemma for many clinicians. The misdiagnosis of an acute or progressive chronic cardiac etiology may carry a significant risk of morbidity and mortality. This review summarizes the different options and modalities for establishing the diagnosis and severity of coronary artery disease.

Asymptomatic surveillance testing for COVID-19 in health care professional students: lessons learned from a low prevalence setting.

The novel coronavirus disease of 2019 (COVID-19) pandemic has severely impacted the training of health care professional students because of concerns of potential asymptomatic transmission to colleagues and vulnerable patients. From May 27th, 2020, to June 23rd 2021; at a time when B.1.

Perspectives of Recent Graduates on Clerkship Procedural Skill Training at a Canadian Medical School: an Exploratory Study.

The implementation of competency-based medical education in Canada has presented both unique opportunities and challenges for improving undergraduate procedural skills curricula. Despite the recognized importance of procedural skills, there remains a lack of national congruency in procedural training across medical schools that must be addressed. When undertaking such curricular development, obtaining learner feedback is a crucial step that can facilitate practical changes and address disparities.

Impact of a Mandated Accreditation Process on 1,045 Registered Echocardiographic Service Providers in a Previously Unregulated, Publicly Funded Environment.

Background: This review was undertaken to examine the impact of a standards-based, mandated accreditation process on several aspects of echocardiographic service delivery in a single-payer, previously unregulated environment.

Methods: In the province of Ontario, virtually all echocardiographic services are funded by the Ministry of Health and Long Term Care. The Echocardiography Quality Improvement (EQI) process was introduced in 2012 and subsequently linked formally to reimbursement in 2016.

Student Reflections on the Queen's Accelerated Route to Medical School Programme.

Context: Since its inception more than 150 years ago, the School of Medicine at Queen's University has aspired 'to advance the tradition of preparing excellent physicians and leaders in health care by embracing a spirit of inquiry and innovation in education and research'. As part of this continuing commitment, Queen's School of Medicine developed the Queen's University Accelerated Route to Medical School (QuARMS). As Canada's only 2-year accelerated-entry premedical programme, QuARMS was designed to reduce training time, the associated expense of medical training, and to encourage a collaborative premedical experience.

Smoothing the Transition Points in Canadian Medical Education.

In 2010, the Association of Faculties of Medicine of Canada, Collège des médecins du Québec, College of Family Physicians of Canada, and Royal College of Physicians and Surgeons of Canada launched the Future of Medical Education in Canada Postgraduate (FMEC PG) Project to examine postgraduate medical education (PGME) in Canada and make recommendations for improvement. One recommendation that emerged concerns the transitions learners experience across the undergraduate medical education-PGME-practice continuum. The FMEC PG, using a thorough process, developed projects to address these often-tumultuous transitions for the learner, aiming to provide support, tools, and standards for the learner's educational journey.

The Surgical Skills and Technology Elective Program (SSTEP): A comprehensive simulation-based surgical skills initiative for preclerkship medical students.

Background: The Surgical Skills and Technology Elective Program (SSTEP) is a voluntary preclerkship surgical bootcamp that uses simulation learning to build procedural knowledge and technical skills before clerkship.

Methods: Eighteen second year students (n = 18) participated in simulation workshops over the course of 7 days to learn clerkship-level procedural skills. A manual was supplied with the program outline.

A quality control exercise in the echo laboratory: Reduction in inter-observer variability in the interpretation of pulmonary hypertension.

Background: Right ventricular systolic pressure (RVSP) estimated by echocardiography is critical for the initial screening and follow-up of pulmonary hypertension (PH). Inter-observer variability (IOV) in RVSP can impact clinical decision making. This study assessed whether a simple guideline-based teaching intervention could reduce the IOV in RVSP interpretation.

Examining the impact of early longitudinal patient exposure on medical students' career choices.

Background: Medical schools include career direction experiences to help students make informed career decisions. Most experiences are short, precluding students from attaining adequate exposure to long-term encounters within medicine. We investigated the impact of the First Patient Program (FPP), which fosters longitudinal patient exposure by pairing junior medical students with chronically ill patients through their healthcare journey, in instilling career direction.

Mitral chordal-leaflet-myocardial interactions in mitral valve prolapse.

Background: The submitral apparatus maintains annular-papillary continuity and myocardial geometry. In mitral valve prolapse (MVP), elongated chords and redundant leaflets can interact at the region of myocardial attachment, leading to apparent discordant motion of the basal inferolateral wall. The aim of this study was to test the hypothesis that basal inferolateral wall inward motion would occur later in MVP and that this delay is associated with MVP severity.

Development and evaluation of methodologies for teaching focused cardiac ultrasound skills to medical students.

Background: Handheld ultrasound is emerging as an important tool for point-of-care cardiac assessment. Although cardiac ultrasound skills are traditionally introduced during postgraduate training, the optimal time and methodology to initiate training in focused cardiac ultrasound (FCU) are unknown. The objective of this study was to develop and evaluate a novel curriculum for training medical students in the use of FCU.

Standards for provision and accreditation of echocardiography in Ontario.

In March of 2010, the Ontario Ministry of Health and Long-term Care and Ontario Medical Association jointly commissioned a Working Group to make recommendations regarding the provision and accreditation of echocardiographic services in Ontario. That commission undertook a process to examine all aspects of the provision, reporting and interpretation of echocardiographic examinations, including the echocardiographic examination itself, facilities, equipment, reporting, indications, and qualifications of personnel involved in the acquisition and interpretation of studies. The result was development of a set of 54 performance standards and a process for accreditation of echocardiographic facilities, initially on a voluntary basis, but leading to a process of mandatory accreditation.

A post-myectomy heart: 20 years later.

We present the case of a 20-year old male that underwent a surgical ventricular septal myectomy at 8 months of age for symptomatic and drug-refractory obstructive hypertrophic cardiomyopathy (HCM). Though he has remained asymptomatic since the operation, he now demonstrates findings of cardiac arrhythmia and left ventricular dysfunction. His case is of particular interest as it represents a detailed and lengthy follow-up from early childhood to adulthood.

Primary cardiac diffuse large B cell lymphoma presenting with superior vena cava syndrome.

Primary cardiac lymphomas are rare extranodal lymphomas that should be distinguished from secondary cardiac involvement by disseminated non-Hodgkin's lymphoma. Cardiac lymphomas often mimic other cardiac neoplasms, including myxomas and angiosarcomas, and often require multimodality cardiac imaging, in combination with endomyocardial biopsy, excisional biopsy or pericardial fluid cytology, to establish a definitive diagnosis. A 60-year-old immunocompetent man who presented with superior vena cava syndrome secondary to a right atrial, primary cardiac diffuse large B cell lymphoma (non-Hodgkin's lymphoma) is described in the present article.

Effect of long-term aspirin use on embolic events in infective endocarditis.

Background: In a recent clinical trial, aspirin therapy was initiated approximately 34 days after the onset of symptoms but did not reduce the risk of embolism in patients with endocarditis. However, it is possible that aspirin used early in the course of the disease may be beneficial. The purpose of the study is to assess the effect of long-term daily aspirin use on the risk of embolic events in patients with infective endocarditis.

Warfarin and aortic valve calcification in hemodialysis patients.

Background: This retrospective cohort study was designed to determine the association between long-term exposure to warfarin and severity of aortic valve (AV) calcification in hemodialysis (HD) patients.

Methods: One hundred and eight HD patients underwent a study-specific echocardiogram. A grading scheme was used to classify AV calcification as none, mild, moderate and severe.

Canadian guidelines for training in adult perioperative transesophageal echocardiography. Recommendations of the Cardiovascular Section of the Canadian Anesthesiologists' Society and the Canadian Society of Echocardiography.

Purpose: To establish Canadian guidelines for training in adult perioperative transesophageal echocardiography (TEE).

Methods: Guidelines were established by the Canadian Perioperative Echocardiography Group with the support of the cardiovascular section of the Canadian Anesthesiologists' Society in conjunction with the Canadian Society of Echocardiography. Guidelines for training in echocardiography by the American Society of Echocardiography, the American College of Cardiology and the Society of Cardiovascular Anesthesiologists were reviewed, modified and expanded to produce the 2003 Quebec expert consensus for training in perioperative echocardiography.

Canadian guidelines for training in adult perioperative transesophageal echocardiography. Recommendations of the Cardiovascular Section of the Canadian Anesthesiologists' Society and the Canadian Society of Echocardiography.

Purpose: To establish Canadian guidelines for training in adult perioperative transesophageal echocardiography (TEE).

Methods: Guidelines were established by the Canadian Perioperative Echocardiography Group with the support of the cardiovascular section of the Canadian Anesthesiologists' Society (CAS) in conjunction with the Canadian Society of Echocardiography. Guidelines for training in echocardiography by the American Society of Echocardiography, the American College of Cardiology and the Society of Cardiovascular Anesthesiologists were reviewed, modified and expanded to produce the 2003 Quebec expert consensus for training in perioperative echocardiography.

Guidelines for the provision of echocardiography in Canada: recommendations of a joint Canadian Cardiovascular Society/Canadian Society of Echocardiography Consensus Panel.

Recognizing the central role of echocardiographic examinations in the assessment of most cardiac disorders and the need to ensure the provision of these services in a highly reliable, timely, economical and safe manner, the Canadian Cardiovascular Society and Canadian Society of Echocardiography undertook a comprehensive review of all aspects influencing the provision of echocardiographic services in Canada. Five regional panels were established to develop preliminary recommendations in the five component areas, which included the echocardiographic examination, the echocardiographic laboratory and report, the physician, the sonographer and indications for examinations. Membership in the panels was structured to recognize the regional professional diversity of individuals involved in the provision of echocardiography.

Stress echocardiography in the evaluation of women presenting with chest pain syndrome: a randomized, prospective comparison with electrocardiographic stress testing.

Objective: To evaluate the relative value of three stress testing modalities for establishing the presence of coronary artery disease in women presenting with chest pain.

Background: Echocardiographic testing modalities have the potential to be more effective than standard electrocardiographic stress testing (EST), but they require prospective evaluation.

Methods: Patients with no cardiac history and at least two cardiac risk factors were randomly assigned to one of three initial diagnostic strategies: treadmill EST (n=54), treadmill echocardiographic stress testing (ExE) (n=57) or dobutamine stress echocardiography (DSE) (n=47).

Defining low risk for coronary heart disease among women with chest pain syndrome: a prospective evaluation.

Background: A better understanding of the clinical manifestations of coronary disease in women may lead to earlier recognition and better outcomes.

Methods: One hundred fifty-eight women coming to primary care physicians, emergency rooms, or cardiology clinics with undefined chest pain and at least two risk factors underwent detailed clinical evaluation of risk factor profile and symptom characteristics as well as stress testing. The significance of the presenting symptoms was evaluated on the basis of clinical events during an average 26.