The Canadian Pediatric Surgery Workforce: A 10-year Prospective Assessment.

Background: The Canadian Association of Paediatric Surgeons launched a 10-year prospective assessment of the Canadian pediatric surgery workforce and training environment, beginning in 2013. The results of the first 5 years (2013-2017) were previously published. Here, we present the results of the last 5 years (2018-2022), and the cumulative results of the past decade.

Training low-middle-income (LMIC) pediatric surgeons in a high-income country (HIC) program.

Background: A popular paradigm to support surgical education for low- and middle-income countries (LMICs) is partnering with high-income country (HIC) surgeons. These relationships may, however, be asymmetric and fail to optimally address the most pressing curricular needs. We explored the effectiveness of our LMIC-HIC educational partnership.

Evaluation of Interventions Addressing Timely Access to Surgical Care in Low-Income and Low-Middle-Income Countries as Outlined by the LANCET Commission 2030 Global Surgery Goals: A Systematic Review.

Background: In 2015, the Lancet Commission on Global Surgery published six global surgery goals, one of which was to provide 80% of the world's population with timely access to the Bellwether Surgical procedures. Little is known about the prevalence or efficacy of subsequent interventions implemented in under-resourced countries to increase timely access to Bellwether surgical procedures.

Methods: A systematic review of articles and grey literature published in MEDLINE, Embase, Cochrane, CINAHL, and Web of Science databases was conducted.

Ten Global Surgical Care Statements for Children: examining our commitment to the future.

Background: The lack of access to essential surgery for many of our world's children is a global health crisis. A third of all deaths in the pediatric population are due to surgical conditions. In low- and middle-income countries, an average of nine in ten children lack access to basic surgical care.

Engaging medical trainees in resource stewardship through resident-led teaching sessions: a choosing wisely educational initiative.

Implication Statement Overuse of healthcare resources is prevalent, including among medical trainees. As front-line clinicians and near-peers, residents are well-positioned to teach resource stewardship to medical students and address barriers students may face while trying to "choose wisely." We describe the implementation of two resident-led, case-based teaching sessions for medical students that focus on resource stewardship.

The thyroid nodules in kids study (ThyNK study): An evaluation of clinical practice variation.

Purpose: The purpose of this study was to evaluate the management of thyroid nodules in children and assess clinical practice variation (CPV) using the 2015 American Thyroid Association (ATA) guidelines as a standard.

Methods: Pediatric patients presenting to a tertiary care pediatric centre with a thyroid nodule from 2007 to 2017 were retrospectively analyzed. Demographic and disease specific information were collected.

The Teacher-Learner Contract (TLC): An Objectives-Based Checklist for Surgical Shadowing.

Objective: A lack of structure and communication in physician shadowing experiences may prevent medical students from accruing its potential benefits. In this study, we evaluated the use of an objectives-based surgical shadowing teacher-learner contract (TLC) on the outcomes of shadowing experiences.

Design: Cross-sectional study with 30 unique student-surgeon pairs who participated in a 1-time shadowing experience between December 2016 and May 2017.

Spindle Epithelial Tumor with Thymus-Like Differentiation (SETTLE): A Case Report.

Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a tumor with an indolent disease course and late metastatic potential. It occurs primarily in children and adolescents, although it can present later in life. It was first described by Chan and Rosai [Tumors of the neck showing thymic or related branchial pouch differentiation: a unifying concept.

The Canadian pediatric surgery workforce: A 5-year prospective study.

Background: In 2014, a survey study of the Canadian pediatric surgery workforce predicted a need for 2 new pediatric surgeons/yr. in Canada. We sought to assess these predictions and evaluate the status of the workforce.

Canadian Association of Pediatric Surgeons' state of wellness.

The following is a summary of the fourth Ein Panel Debate Session from the 50th Annual Meeting of the Canadian Association of Pediatric Surgeons (CAPS) held in Toronto, ON, from September 26-29, 2018. The session focused on surgeon well-being at different stages of career: role of mentorship at the start of career, second victim syndrome, litigation stress syndrome, and retirement. Using Maslach Burnout Inventory Survey, CAPS members were presented their wellness scores as a group compared to other health care providers.

Unifying Children's Surgery and Anesthesia Stakeholders Across Institutions and Clinical Disciplines: Challenges and Solutions from Uganda.

Background: There is a significant unmet need for children's surgical care in low- and middle-income countries (LMICs). Multidisciplinary collaboration is required to advance the surgical and anesthesia care of children's surgical conditions such as congenital conditions, cancer and injuries. Nonetheless, there are limited examples of this process from LMICs.

Application of genomics to identify therapeutic targets in recurrent pediatric papillary thyroid carcinoma.

Children with papillary thyroid carcinoma (PTC) may relapse despite response to radioactive iodine (RAI). Two children with multiply relapsed PTC underwent whole-genome and transcriptome sequencing. A fusion was identified in one tumor, with outlier expression compared to the TCGA thyroid cancer compendium and to Illumina BodyMap normal thyroid.

Engaging youth in rural Uganda in articulating health priorities through Photovoice.

Youth living in rural Uganda represent over 20% of the country's population. Despite the size of this demographic segment of the population, there is a paucity of data on their health priorities. Engaging people in understanding their own health status has proven to be an effective mechanism for health promotion.

Variation in the Diagnosis and Management of Appendicitis at Canadian Pediatric Hospitals.

Objectives: The objective was to characterize the variations in practice in the diagnosis and management of children admitted to hospitals from Canadian pediatric emergency departments (EDs) with suspected appendicitis, specifically the timing of surgical intervention, ED investigations, and management strategies.

Methods: Twelve sites participated in this retrospective health record review. Children aged 3 to 17 years admitted to the hospital with suspected appendicitis were eligible.

Costs and cost-effectiveness of pediatric inguinal hernia repair in Uganda.

Background: Surgically treatable diseases contribute approximately 11% of disability-adjusted life years (DALYs) worldwide yet they remain a neglected public health priority in low- and middle-income countries (LMICs). Pediatric inguinal hernia is the most common congenital abnormality in newborns and a major cause of morbidity and mortality yet elective repair remains largely unavailable in LMICs. This study is aimed to determine the costs and cost-effectiveness of pediatric inguinal hernia repair (PIHR) in a low-resource setting.

Pediatric surgical camps as one model of global surgical partnership: a way forward.

Background/purpose: A uniquely Ugandan method of holding surgical "camps" has been one means to deal with the volume of patients needing surgery and provides opportunities for global partnership.

Methods: We describe an evolved partnership between pediatric surgeons in Uganda and Canada wherein Pediatric Surgical Camps were organized by the Ugandans with team participation from Canadians. The camp goals were to provide pediatric surgical and anesthetic service and education and to foster collaboration as a way forward to assist Ugandan health delivery.

A survey-based assessment of the Canadian pediatric surgery workforce.

Background: There is significant lack of information regarding the Canadian pediatric surgery workforce.

Methods: An IRB-approved survey aimed at assessing workforce issues was administered to pediatric surgeons and pediatric surgery chiefs in Canada in 2012.

Results: The survey was completed by 98% of practicing surgeons and 13 of the 18 division chiefs.

Use of surgical task shifting to scale up essential surgical services: a feasibility analysis at facility level in Uganda.

Background: The shortage and mal-distribution of surgical specialists in sub-Saharan African countries is born out of shortage of individuals choosing a surgical career, limited training capacity, inadequate remuneration, and reluctance on the part of professionals to work in rural and remote areas, among other reasons. This study set out to assess the views of clinicians and managers on the use of task shifting as an effective way of alleviating shortages of skilled personnel at a facility level.

Methods: 37 in-depth interviews with key informants and 24 focus group discussions were held to collect qualitative data, with a total of 80 healthcare managers and frontline health workers at 24 sites in 15 districts.

Gastric hamartoma of the pylorus in an infant.

Gastric hamartomata, alternatively called adenomyomata, are rare, benign lesions of the gastric wall. They can present with a wide spectrum of symptomatology. Pure pyloric adenomyomata are exceedingly rare.

Prediction of pediatric outcome after prenatal diagnosis and expectant antenatal management of congenital cystic adenomatoid malformation.

Objective: To determine whether the congenital cystic adenomatoid malformation (CCAM) volume ratio (CVR) is associated with fetal and postnatal outcome after prenatal diagnosis and antenatal expectant management in a provincial tertiary referral center that does not offer fetal surgery.

Methods: Retrospective cohort of 71 consecutive cases of prenatally diagnosed CCAM meeting study criteria (1996-2004). CVR was calculated on the initial ultrasound at the referral center, and associated with hydrops (Fisher's exact test) and a composite adverse postnatal outcome consisting of death, intubation for respiratory distress, extracorporeal membrane oxygenation, non-elective surgery for symptomatology, or respiratory infection requiring hospital admission (Mann-Whitney test).

Pediatric surgical capacity and demand: analysis reveals a modest gap in capacity and additional efficiency opportunities.

The Canadian Paediatric Surgical Wait Times Project conducted an analysis of the alignment between capacity (supply) and demand for pediatric surgery at nine participating hospitals in five provinces. Demand for surgery was modelled using wait list data by assigning patients into monthly buckets of demand ("demand windows") based on the date on which a decision was made to proceed with their surgery plus their surgical wait time access target. Demand was then related to available capacity for various key resources (e.