Canadian CT head rule adherence in a rural hospital without in-house computed tomography.

Introduction: We sought to determine the difference between Canadian CT Head Rule (CCHR) indicated imaging rates and actual imaging rates for patients with mild traumatic brain injuries (mTBIs) at a rural emergency department (ED) without in-house computed tomography (CT). In addition, we compared CCHR adherence at a hospital without CT to previous publications from centres with CT to determine if rural populations receive less CT imaging for minor head traumas when indicated by the CCHR.

Methods: This retrospective chart review explored individuals who presented to a rural ED (no in-house CT scanner) with a primary diagnosis of mild head injury or concussion between 1 January 2017 and 31 December 2021.

Comparison of risk-adjusted cumulative quality control charts compared with standardized mortality ratios in critical care.

Purpose: The optimal method for monitoring intensive care unit (ICU) performance is unknown. We sought to compare process control charts using standardized mortality ratio (SMR), p-charts, and cumulative sum (CUSUM) charts for detecting increases in risk-adjusted mortality within ICUs.

Methods: Using data from 17 medical-surgical ICUs that included 29,592 patients in Ontario, Canada, we created risk-adjusted p-charts and SMRs on monthly intervals and CUSUM charts.

Beyond the Clinic: How Coaching Elevates Nephrology Nursing Practice.

Coaching can enhance individual performance and promote a culture of collaboration and quality in the clinical setting. By utilizing the tools and skills inherent to coaching, individual and team outcomes can be elevated. In this article, an experienced nephrology nurse, who is also a certified coach, describes how the use of a coaching approach in professional development can lead to positive impact on workplace culture, and describes how nephrology nurses and leaders are in a key position to utilize aspects of coaching to enhance team cohesiveness, collaboration, and ultimately, patient outcomes.

Endoscopic Education, Training, and Simulation.

This article summarizes the evolution of endoscopy training from its origins of simple bedside instruction to its current state of competency-based curricula and incorporation of novel training methods, including simulation, gamification for the trainee, and improving education skills of the tutors.

Molecular Markers in Follicular and Oncocytic Thyroid Carcinomas: Clinical Application of Molecular Genetic Testing.

Background: Oncocytic thyroid carcinoma (OTC) was previously considered a variant of follicular thyroid carcinoma (FTC) but has recently been reclassified as a separate form of thyroid cancer. This study aimed to demonstrate that FTC and OTC are fundamentally distinct entities that can potentially be differentiated preoperatively through cytology and/or molecular testing.

Methods: A retrospective chart review of patients diagnosed with FTC and OTC operated upon at two university health centers from January 2016 to September 2023 (n = 3219) was conducted.

Disease Activity in Pregnant and Postpartum Women With Multiple Sclerosis Receiving Ocrelizumab or Other Disease-Modifying Therapies.

Background And Objectives: Women with multiple sclerosis (MS) are at risk of disease reactivation in the early postpartum period. Ocrelizumab (OCR) is an anti-CD20 therapy highly effective at reducing MS disease activity. Data remain limited regarding use of disease-modifying therapies (DMTs), including OCR, and disease activity during peripregnancy periods.

Feasibility of ctDNA in detecting minimal residual disease and predicting recurrence for colorectal cancer liver metastases.

Introduction: Approximately 50% of patients diagnosed with colorectal cancer develop colorectal cancer liver metastases (CRLM). Although curative intent liver resection provides 5-year survival of 40-50%, up to 70% of patients develop recurrence of CRLM. Detection of minimal residual disease (MRD) is essential for timely, optimized treatment.

Gender differences in spine surgery for degenerative lumbar disease: prospective cohort study.

Objective: Despite efforts toward achieving gender-based equality in clinical trial enrollment, females are frequently underrepresented and gender-specific data analysis is lacking. Identifying and addressing gender bias in medical decision-making and outcome reporting may facilitate more equitable healthcare delivery. This study aimed to determine if gender differences exist in the clinical evaluation and surgical management of patients with degenerative lumbar conditions.

Global distribution and career outcomes of international fellows trained in Canadian gynecologic oncology programs.

Objective: We assessed the global distribution and academic, administrative and research outcomes of international fellows (IFs) trained in Canadian gynecologic oncology (GO) programs.

Methods: A web-based survey was sent to IFs who completed GO training in Canada. Using the Web of science database, we identified the publication list, citation record and H-index of IFs and classified them according to their region of practice: high-income countries (HIC), middle income countries (MIC), and low-income countries (LIC).

An Environmental Scan of Canadian Kidney Transplant Programs for the Management of Patients With Graft Failure: A Research Letter.

Background: Kidney transplant recipients with graft failure (KTR-GF) and those with a failing graft are an increasingly prevalent group of patients. Their clinical management is complex, and outcomes are worse than transplant naïve patients on dialysis. In 2023, the Kidney Disease: Improving Global Outcomes (KDIGO) organization reported findings from a controversies conference and identified several clinical practice priorities for KTR-GF.

Soft tissue tumors of the lower leg, foot and ankle: A cross-sectional observational study analysing 376 cases.

Fewer than 5 % of soft tissue sarcomas arise in the foot and ankle. It can be difficult to distinguish between benign and malignant lesions which leads to a delay in diagnosis. Initial inappropriate procedures limit options for limb salvage and increasing rates of local recurrence.

Multiomics of the intestine-liver-adipose axis in multiple studies unveils a consistent link of the gut microbiota and the antiviral response with systemic glucose metabolism.

Background: The microbiota is emerging as a key factor in the predisposition to insulin resistance and obesity.

Objective: To understand the interplay among gut microbiota and insulin sensitivity in multiple tissues.

Design: Integrative multiomics and multitissue approach across six studies, combining euglycaemic clamp measurements (used in four of the six studies) with other measurements of glucose metabolism and insulin resistance (glycated haemoglobin (HbA1c) and fasting glucose).

Histopathological Growth Patterns Determine the Outcomes of Colorectal Cancer Liver Metastasis Following Liver Resection.

Introduction: Colorectal cancer liver metastasis (CRCLM) remains a lethal diagnosis, with an overall 5-year survival rate of 5-10%. Two distinct histopathological growth patterns (HGPs) of CRCLM are known to have significantly differing rates of patient survival and response to treatment. We set out to review the results of 275 patients who underwent liver resection for CRCLM at the McGill University Health Center (MUHC) and analyze their clinical outcome, mutational burden, and pattern of cancer progression in light of their HGPs, and to consider their potential effect on surgical decision making.

Efficacy and safety of therapeutic alpha-1-microglobulin RMC-035 in reducing kidney injury after cardiac surgery: a multicentre, randomised, double-blind, parallel group, phase 2a trial.

Background: Cardiac surgery invariably triggers acute kidney stress causing adverse renal outcomes. The AKITA study evaluated the efficacy and safety of RMC-035, a novel analogue of alpha-1-microglobulin, for reducing cardiac surgery-associated kidney injury.

Methods: In this randomised double-blind placebo-controlled phase 2a study, we randomly assigned (1:1) adult hospitalised patients undergoing open-chest cardiac surgery at high risk for acute kidney injury (AKI) at 21 sites in North America and Europe to receive either RMC-035 (1.

Robotic and Laparoscopic Adrenalectomy for Pheochromocytoma: An International Multicenter Study.

Background And Objective: Robotic adrenalectomy (RA) has attracted interest as an alternative to laparoscopic adrenalectomy (LA) for patients with pheochromocytoma, although its beneficial effects are uncertain. Our aim was to compare RA and LA outcomes for these patients.

Methods: Data for patients who underwent RA or LA for pheochromocytoma in 46 international centers between 2012 and 2022 were reviewed.

Repetitive Transcranial Magnetic Stimulation (rTMS) in Major Depression.

Major depressive disorder (MDD) is a psychiatric disorder with several effective therapeutic approaches, being antidepressants and psychotherapies the first-line treatments. Nonetheless, due to side effects, limited efficacy, and contraindications for these treatments, alternative treatment options are required. Neurostimulation is a non-pharmacological and non-psychotherapeutic approach that has been under study for diverse neuropsychiatric conditions in the form of electrical or magnetic stimulation of the brain.

Why do thoracic epidurals fail? A literature review on thoracic epidural failure and catheter confirmation.

Thoracic epidural anesthesia (TEA) has been the gold standard of perioperative analgesia in various abdominal and thoracic surgeries. However, misplaced or displaced catheters, along with other factors such as technical challenges, equipment failure, and anatomic variation, lead to a high incidence of unsatisfactory analgesia. This article aims to assess the different sources of TEA failure and strategies to validate the location of thoracic epidural catheters.

Biomechanical design of a new proximal humerus fracture plate using alternative materials.

Comminuted proximal humerus fractures are often repaired by metal plates, but potentially still experience bone refracture, bone "stress shielding," screw perforation, delayed healing, and so forth. This "proof of principle" investigation is the initial step towards the design of a new plate using alternative materials to address some of these problems. Finite element modeling was used to create design graphs for bone stress, plate stress, screw stress, and interfragmentary motion via three different fixations (no, 1, or 2 "kickstand" [KS] screws across the fracture) using a wide range of plate elastic moduli (E = 5-200 GPa).