Replacing post-chest tube removal chest radiographs with clinical assessment in adult thoracic surgery patients: A single-center prospective study.

Objective: The necessity and utility of chest radiographs in the absence of clinical symptoms have been questioned after chest tube removal. This study aimed to evaluate the impact of replacing routine chest radiographs after chest tube removal with clinical observation on outcomes in patients undergoing elective thoracic surgery.

Methods: This was a single-center prospective study of adult patients undergoing elective lung resection.

Video-assisted thoracoscopic resection of a giant esophageal schwannoma: A case report.

Introduction And Importance: Intrathoracic schwannomas are rare and difficult to diagnose. However, they are the most common type of neurogenic tumor in the chest. Most patients are incidentally diagnosed or develop symptoms from mass effect, such as chest pain, dysphagia or dyspnea.

Surgical Repair of Atrial-Esophageal Fistula Following Catheter Ablation.

Left atrial-esophageal fistula after radiofrequency ablation for atrial fibrillation is a rare and potentially lethal complication. Although surgical management is associated with improved outcomes, the optimal approach remains to be elucidated. We describe a case of atrial-esophageal fistula treated with a simultaneous repair of the atrium and esophagus via a right thoracotomy with an extrapericardial off-pump approach.

A Standardized Minimal Opioid Prescription Post-Thoracic Surgery Provides Adequate Pain Control.

Background: Given the national opioid crisis, postoperative analgesia at discharge must be thoughtfully prescribed. Data specifically related to thoracic procedures remain scarce. This study assessed adequacy of pain control with standardized and limited opioids after thoracic procedures.

Regional differences in use of endoscopic ultrasonography in Ontario: a population-based retrospective cohort study.

Background: Endoscopic ultrasonography is a safe and accurate modality for evaluating and managing hepatobiliary and gastrointestinal conditions (malignant and nonmalignant); its use is increasing. The aim of this study was to describe regional trends in the use of endoscopic ultrasonography in Ontario.

Methods: We conducted a population-based retrospective cohort study using health administrative databases.

Incidence and characteristics of needlestick injuries among medical trainees at a community teaching hospital: A cross-sectional study.

Objectives: This field study aimed to determine the incidence and distribution of needlestick injuries among medical trainees at a community teaching hospital in Toronto, Canada.

Methods: The study was performed during the 2013-2015 academic years at Toronto East General Hospital (TEGH), a University of Toronto-affiliated community-teaching hospital during the 2013-2015 academic years. Eight-hundred and forty trainees, including medical students, residents, and post-graduate fellows, were identified and invited via email to participate in an anonymous online fluidsurveys.

When should a diagnosis of influenza be considered in adults requiring intensive care unit admission? Results of population-based active surveillance in Toronto.

Introduction: There is a paucity of data about the clinical characteristics that help identify patients at high risk of influenza infection upon ICU admission. We aimed to identify predictors of influenza infection in patients admitted to ICUs during the 2007/2008 and 2008/2009 influenza seasons and the second wave of the 2009 H1N1 influenza pandemic as well as to identify populations with increased likelihood of seasonal and pandemic 2009 influenza (pH1N1) infection.

Methods: Six Toronto acute care hospitals participated in active surveillance for laboratory-confirmed influenza requiring ICU admission during periods of influenza activity from 2007 to 2009.

Dealing with aggressive behavior within the health care team: a leadership challenge.

During an interdisciplinary Canadian leadership forum [ (click on the Conferences icon)], participants were challenged to develop an approach to a difficult leadership/management situation. In a scenario involving aggressive behavior among health care providers, participants identified that, before responding, an appropriate leader should collect additional information to identify the core problem(s) causing such behavior. Possibilities include stress; lack of clear roles, responsibilities, and standard operating procedures; and, finally, lack of training on important leadership/management skills.

Activated protein C in normal human pregnancy and pregnancies complicated by severe preeclampsia: a therapeutic opportunity?

Objectives: Given the efficacy and safety of recombinant human activated protein C (rhAPC) in the systemic inflammatory response syndrome, this study was designed to review the evidence for a role for APC in the pathogenesis of preeclampsia. Preeclampsia is a proinflammatory and procoagulant state, and it is a pregnancy-specific condition that mimics the systemic inflammatory response syndrome. rhAPC reduces mortality in patients with systemic inflammatory response syndrome and could potentially have a role as disease-modifying therapy in preeclampsia.

Pro/con clinical debate: are steroids useful in the management of patients with septic shock?

Decision-making in the intensive care unit is often very difficult. Although we are encouraged to make evidence-based decisions, this may be difficult for a number of reasons. To begin with, evidence may not exist to answer the clinical question.