A Canadian strategy for surgical quality improvement.

The Canadian Association of General Surgeons (CAGS) Board of Directors hosted a symposium to develop a Canadian strategy for surgical quality and safety at its mid-term meeting on Feb. 24, 2018. The following 6 principles outline the consensus of this symposium, which included diverse stakeholders and surgeon leaders across Canada: 1) a Canadian quality-improvement strategy for surgery is needed; 2) quality improvement requires continuous, active and intentional effort; 3) outcome measurement alone will not drive improvement; 4) increased focus on standardization and process improvement is necessary; 5) new, large electronic medical record systems pose challenges as well as benefits in Canadian hospitals; and 6) surgeons in remote and rural hospitals must be engaged using tailored approaches.

General surgery 2.0: the emergence of acute care surgery in Canada.

Over the past 5 years, there has been a groundswell of support in Canada for the development of organized, focused and multidisciplinary approaches to caring for acutely ill general surgical patients. Newly forged acute care surgery (ACS) services are beginning to provide prompt, evidence-based and goal-directed care to acutely ill general surgical patients who often present with a diverse range of complex pathologies and little or no pre- or postoperative planning. Through a team-based structure with attention to processes of care and information sharing, ACS services are well positioned to improve outcomes, while finding and developing efficiencies and reducing costs of surgical and emergency health care delivery.

Is the script concordance test a valid instrument for assessment of intraoperative decision-making skills?

Background: Intraoperative decision making requires both knowledge and experience. The script concordance test (SCT), based on cognitive psychology script theory, is a new tool of clinical-reasoning assessment that may be used to evaluate a candidate's approach to ill-defined problems encountered in the operating room.

Methods: To develop and validate an SCT for assessment of intraoperative decision making.

Gene expression signatures of morphologically normal breast tissue identify basal-like tumors.

Introduction: The role of the cellular microenvironment in breast tumorigenesis has become an important research area. However, little is known about gene expression in histologically normal tissue adjacent to breast tumor, if this is influenced by the tumor, and how this compares with non-tumor-bearing breast tissue.

Methods: To address this, we have generated gene expression profiles of morphologically normal epithelial and stromal tissue, isolated using laser capture microdissection, from patients with breast cancer or undergoing breast reduction mammoplasty (n = 44).

Successful use of letrozole in male breast cancer: a case report and review of hormonal therapy for male breast cancer.

Male breast cancer is an uncommon occurrence. Treatment of male breast cancer is typically extrapolated from data on the treatment of female breast cancer. Recently, aromatase inhibition has been proven as an effective therapy for female breast cancer, particularly in the setting of advanced cancers.

Blunt splenic injuries in a Canadian pediatric population: the need for a management guideline.

Objectives: To review practice patterns in a Canadian pediatric centre and develop a safe and effective care plan for managing children with splenic injuries.

Design: A chart review.

Setting: Winnipeg Children's Hospital.