Cultivating a communities of practice for colorectal cancer screening in northern Canada.

Background: Knowledge management systems such as a Communities of Practice (CoP) can improve healthcare processes but are challenging in complex multidisciplinary systems, and guidance on methods to establish a CoP are needed. This case illustrates the use of early stakeholder engagement and Nominal Group Technique (NGT) to cultivate a CoP in a complex multidisciplinary system: colorectal cancer screening in northern Canada.

Methods: Stakeholders in the Northwest Territories, Canada were recruited and co-designed a workshop with authors to introduce CoP concepts and identify priorities.

Participatory simulation modeling to inform colorectal cancer screening in a complex remote northern health system: Canada's Northwest Territories.

Background & Aims: Colorectal cancer (CRC) mortality in the Northwest Territories (NWT), a northern region of Canada, could be reduced by implementing a CRC screening program. However, this may require additional colonoscopy resources. We used participatory simulation modeling to predict colonoscopy demand and to develop strategies for implementing a feasible and effective CRC screening program in this complex remote northern health system.

Impact of colorectal cancer screening participation in remote northern Canada: A retrospective cohort study.

Background: Screening provides earlier colorectal cancer (CRC) detection and improves outcomes. It remains poorly understood if these benefits are realized with screening guidelines in remote northern populations of Canada where CRC rates are nearly twice the national average and access to colonoscopy is limited.

Aim: To evaluate the participation and impact of CRC screening guidelines in a remote northern population.

Barriers to colonoscopy in remote northern Canada: an analysis of cancellations.

Colonoscopy is a critical diagnostic and therapeutic procedure that is challenging to access in northern Canada. In part, this is due to frequent cancellations. We sought to understand the trends and reasons for colonoscopy cancellations in the Northwest Territories (NWT).

Simulation modeling validity and utility in colorectal cancer screening delivery: A systematic review.

Objective: This study sought to assess the impact and validity of simulation modeling in informing decision making in a complex area of healthcare delivery: colorectal cancer (CRC) screening.

Materials And Methods: We searched 10 electronic databases for English-language articles published between January 1, 2008, and March 1, 2019, that described the development of a simulation model with a focus on average-risk CRC screening delivery. Included articles were reviewed for evidence that the model was validated, and provided real or potential contribution to informed decision making using the GRADE EtD (Grading of Recommendations Assessment, Development, and Evaluation Evidence to Decision) framework.

Use of Simulation Modeling to Inform Decision Making for Health Care Systems and Policy in Colorectal Cancer Screening: Protocol for a Systematic Review.

Background: Simulation modeling has frequently been used to assess interventions in complex aspects of health care, such as colorectal cancer (CRC) screening, where clinical trials are not feasible. Simulation models provide estimates of outcomes, unintended consequences, and costs of an intervention; thus offering an invaluable decision aid for policy makers and health care leaders. However, the contribution that simulation models have made to policy and health system decisions is unknown.

Comparison of Ligation of the Intersphincteric Fistula Tract and BioLIFT for the Treatment of Transsphincteric Anal Fistula: A Retrospective Analysis.

Background: Ligation of the intersphincteric fistula tract is a sphincter-preserving technique for the treatment of anal fistulas. The BioLIFT modification involves the placement of a biologic mesh in the intersphincteric plane. Advocates of this modification state improved healing rates, however evidence for this is lacking, and this approach costs significantly more.

A multi-centre randomized controlled trial of open vs closed management of the rectal defect after transanal endoscopic microsurgery.

Aim: Transanal endoscopic microsurgery (TEM) is a technically challenging strategy that allows expanded indications for local excision of rectal lesions. Transluminal suturing is difficult, so open management of the resultant defect is appealing. Expert opinion suggests there is more pain when the defect is left open.

Surgical outcomes of VRAM versus gracilis flaps for the reconstruction of pelvic defects following oncologic resection.

Purpose: Pelvic reconstruction following abdominoperineal resection or pelvic exenteration is associated with signification surgical site morbidity. Immediate pelvic reconstruction with a muscle flap is now the gold standard, associated with reduced perineal morbidity compared to primary closure alone. The purpose of the present study was to directly compare outcomes of VRAM and gracilis flap pelvic reconstruction following oncologic resection.

Do Diagnostic and Procedure Codes Within Population-Based, Administrative Datasets Accurately Identify Patients with Rectal Cancer?

Background: Procedural and diagnostic codes may inaccurately identify specific patient populations within administrative datasets.

Purpose: Measure the accuracy of previously used coding algorithms using administrative data to identify patients with rectal cancer resections (RCR).

Methods: Using a previously published coding algorithm, we re-created a RCR cohort within administrative databases, limiting the search to a single institution.

Can Text-Search Methods of Pathology Reports Accurately Identify Patients with Rectal Cancer in Large Administrative Databases?

Background: The aim of this study is to derive and to validate a cohort of rectal cancer surgical patients within administrative datasets using text-search analysis of pathology reports.

Materials And Methods: A text-search algorithm was developed and validated on pathology reports from 694 known rectal cancers, 1000 known colon cancers, and 1000 noncolorectal specimens. The algorithm was applied to all pathology reports available within the Ottawa Hospital Data Warehouse from 1996 to 2010.

Association between perioperative beta blocker use and cancer survival following surgical resection.

Background: Recent studies have demonstrated an association between beta-blocker exposure and improved survival in multiple cancer types. We sought to investigate the effects of beta-blockers at the time of index surgery for breast, lung, and colorectal cancer.

Materials And Methods: Using linked data from a provincial cancer registry, we conducted a retrospective matched cohort study comparing disease-specific and overall survival between patients over age 64 exposed and not exposed to beta-blockers before and after index surgical resection for breast, lung and colorectal cancer between April 1st, 2002 and December 31st, 2010.

Perianal Pagetoid Intraepithelial Carcinoma.

Extramammary Paget disease (EMPD) involving the perianal region is rare and challenging to manage. Primary EMPD involves stand-alone noninvasive lesions within the epidermis, while secondary EMPD involves phenotypically similar lesions derived from separate underlying malignancies. Differentiating between primary and secondary EMPD is challenging when no underlying malignancies are detected during workup.

The implementation of a transanal endoscopic microsurgery programme: initial experience with surgical performance.

Aim: Despite transanal endoscopic microsurgery (TEM) being used for over 30 years, there has been slow adoption of this modality in many centres. There remains a paucity of research regarding the learning curve and early performance of surgeons who begin to offer TEM. We sought to determine predictors of longer rates of tumour excision and improvements in operative time in a newly established TEM programme.

Evaluation of the Rectal Cancer Patient Decision Aid: A Before and After Study.

Background: In rectal cancer surgery, low anterior resection and abdominoperineal resection have equivocal impact on overall quality of life. A rectal cancer decision aid was developed to help patients weigh features of options and share their preference.

Objective: The aim of this study was to evaluate the effect of a patient decision aid for mid to low rectal cancer surgery on the patients' choice and decision-making process.

Laparoscopic Colorectal Surgery in the Emergency Setting: Trends in the Province of Ontario.

Background: The purpose of this study was to examine the adoption trends of emergency laparoscopic colorectal surgery in the province of Ontario.

Study Design: We conducted a retrospective time-series analysis examining rates of emergency colorectal surgery among 10.5 million adults in Ontario, Canada from April 1, 2002 to December 31, 2009.

Dynamic article: combined endoscopic-laparoscopic surgery for complex colonic polyps: postoperative outcomes and video demonstration of 3 key operative techniques.

Background: Combined endoscopic-laparoscopic surgery is a novel technique that can be used to avoid bowel resection for complex colon polyps that are not amenable to colonoscopic resection.

Objective: The aim of this study was to evaluate the safety and outcomes of combined endoscopic-laparoscopic surgery for complex colonic polyps.

Design: This study is a retrospective review of consecutive combined endoscopic-laparoscopic surgeries.

Increased expression of tumor necrosis factor-α is associated with advanced colorectal cancer stages.

Aim: To detect the expression of tumor necrosis factor-α (TNF-α) in colorectal cancer (CRC) cells among Saudi patients, and correlate its expression with clinical stages of cancer.

Methods: Archival tissue specimens were collected from 30 patients with CRC who had undergone surgical intervention at King Khalid University Hospital. Patient demographic information, including age and gender, tumor sites, and histological type of CRC, was recorded.

Autologous Fat Grafting as a Novel Approach to Parastomal Soft-tissue Volume Deficiencies.

The aim of this study is to describe a novel approach to revise maladaptive soft-tissue contour around an ileostomy. A patient with permanent ileostomy suffered from significant defects in soft-tissue contour due to scarring and wound contraction. He underwent autologous fat grafting to achieve sealing of his stoma appliance and improve cosmesis.

The evaluation of a rectal cancer decision aid and the factors influencing its implementation in clinical practice.

Background: Colorectal cancer is common in North America. Two surgical options exist for rectal cancer patients: low anterior resection with re-establishment of bowel continuity, and abdominoperineal resection with a permanent stoma. A rectal cancer decision aid was developed using the International Patient Decision Aid Standards to facilitate patients being more actively involved in making this decision with the surgeon.

Piloting a regional collaborative in cancer surgery using a "community of practice" model.

Background: Patients requiring assessment for cancer surgery encounter a complex series of steps in their cancer journey. Further complicating the process is the fact that care is often delivered in a fragmented, silo-based system. Isolated strategies to improve cancer outcomes within those systems have had inconsistent results.

Exploring a "community of practice" methodology as a regional platform for large-scale collaboration in cancer surgery-the Ottawa approach.

Pressing challenges have forced health care providers to rethink traditional silos and professional boundaries. Communities of practice (cops) have been identified as a means to share knowledge across silos and boundaries. However, clarity sufficient to enable their easy and uniform reproducibility is lacking, leading to a gap between cop conceptualization and implementation.

Plastic freezer bags: a cost-effective method to protect extraction sites in laparoscopic colorectal procedures?

Purpose: To review surgical-site infection (SSI) and retrieval-site tumor recurrence rates in laparoscopic colorectal procedures when using a plastic freezer bag as a wound protector.

Methods: Laparoscopic colorectal procedures where a plastic freezer bag used as a wound protector at the extraction site were reviewed between 1991 and 2008 from a prospectively collected database. χ test was used to compare SSI and tumor recurrence rates between groups.