Evaluation Of Conservative And Operative Treatments In Active Patients With Acromioclavicular (Ac) And Rotator Cuff (Rc) Injuries, Jesse Singh

Electronic Thesis and Dissertation Repository

Abstract

Introduction: Shoulder pain and disability, particularly acromioclavicular joint (ACJ) and rotator cuff (RC) injuries, are common in a physically active population. Determining operative or rehabilitative treatment plans involve multiple treatment choices influenced by the injury grade and treatment goals, such as return to sport. This thesis investigates the management of treatment for AC and RC injuries

Method: The first study is a scoping review that uses the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) to synthesize 32 studies involving athletes who have undergone conservative or operative treatment for their Rockwood grade III …

Development Of An On-Call Assessment Tool For Competency-Based Surgical Training, Eric C. Mitchell

Electronic Thesis and Dissertation Repository

Introduction: A central tenet of competency-based medical education is formative assessment of trainees. There are no assessments examining resident competence on-call, despite this being a significant component of resident training and characterized by less supervision compared to daytime.

Methods: A national survey was conducted to evaluate the state of assessment in Canadian Plastic and Reconstructive Surgery programs. An on-call assessment tool was developed based on a consensus group and was piloted over six months. Validity of the tool was examined through qualitative and quantitative methods.

Results: There were 63 tools completed across ten residents and seven staff physicians. Tool reliability …

Spin And Distortion In Surgical Trials, Andrea Mataruga

Electronic Thesis and Dissertation Repository

Research problem: Randomized controlled trials (RCTs) are essential; however, their validity can be threatened through distortion or spin. This study quantifies publication bias and distorted outcome reporting.

Methodology: All surgical RCTs registered on ClinicalTrials.gov from 1997-2017 were identified and a sample was obtained through random and intentional selection. Failure to publish (proportion of studies that remain unpublished), outcome distortion (changing intended outcomes), and spin (distorted presentation) were explored. Comparisons were made for positive versus negative studies and for high-income (HICs) versus low-middle income countries (LMICs).

Results: In total, 13,761 RCTs were registered (median enrollment size = 96, 94% from …

Natural History Of Very Early Onset Inflammatory Bowel Disease In North America: A Retrospective Cohort Study, Basavaraj Kerur, Eric I. Benchimol, Karoline Fiedler, Marisa Stahl, Jeffrey Hyams, Michael Stephens, Ying Lu, Marian Pfefferkorn, Raza Alkhouri, Jennifer Strople, Judith Kelsen, Leah Siebold, Alka Goyal, Joel R. Rosh, Neal Leleiko, Johan Van Limbergen, Anthony L. Guerrerio, Ross Maltz, Lina Karam, Eileen Crowley, Anne Griffiths, Melvin B. Heyman, Mark Deneau, Keith Benkov, Joshua Noe, Dedrick Mouton, Helen Pappa, Joseph A. Galanko, Scott Snapper

Paediatrics Publications

Background: The incidence of very early onset inflammatory bowel disease (VEOIBD) is increasing, yet the phenotype and natural history of VEOIBD are not well described. Methods: We performed a retrospective cohort study of patients diagnosed with VEOIBD (6 years of age and younger) between 2008 and 2013 at 25 North American centers. Eligible patients at each center were randomly selected for chart review. We abstracted data at diagnosis and at 1, 3, and 5 years after diagnosis. We compared the clinical features and outcomes with VEOIBD diagnosed younger than 3 years of age with children diagnosed with VEOIBD at age …

Optimization Of Percutaneous Biopsy For Diagnosis And Pretreatment Risk Assessment Of Neuroblastoma, Richard E. Overman, Tanvi T. Kartal, Aaron J. Cunningham, Elizabeth A. Fialkowski, Bindi J. Naik-Mathuria, Sanjeev A. Vasudevan, Marcus M. Malek, Ranjeet Kalsi, Hau D. Le, Linda Cherney Stafford, Timothy B. Lautz, Benjamin T. Many, Rachel E. Jones, Andreana Bütter, Jacob Davidson, Andrew Williams, Roshni Dasgupta, Jana Lewis, Misty Troutt, Jennifer H. Aldrink, Sara A. Mansfield, Dave R. Lal, Jerry Xiao, Rebecka L. Meyers, Scott S. Short, Erika A. Newman

Paediatrics Publications

Background: Image-guided percutaneous core needle biopsy (PCNB) is increasingly utilized to diagnose solid tumors. The objective of this study is to determine whether PCNB is adequate for modern biologic characterization of neuroblastoma. Procedure: A multi-institutional retrospective study was performed by the Pediatric Surgical Oncology Research Collaborative on children with neuroblastoma at 12 institutions over a 3-year period. Data collected included demographics, clinical details, biopsy technique, complications, and adequacy of biopsies for cytogenetic markers utilized by the Children's Oncology Group for risk stratification. Results: A total of 243 children were identified with a diagnosis of neuroblastoma: 79 (32.5%) tumor excision at …

Comparison Of Functional And Patient-Reported Outcomes Between Direct Anterior And Lateral Surgical Approach One-Year After Total Hip Arthroplasty In A Canadian Population: A Cross-Sectional Study., Susan W. Hunter, Pavlos Bobos, Lyndsay Somerville, James Howard, Edward Vasarhelyi, Brent Lanting

Physical Therapy Publications

Background: From a clinical perspective, it is important to understand the outcomes that occur after total hip arthroplasty (THA) and do these vary with surgical approach. The objective of the study was to compare physical performance-based and patient-report outcomes between the Direct Anterior (DA) and Direct Lateral (DL) surgical approach at one-year after THA surgery.

Methods: We evaluated patients attending their one-year follow-up assessment after primary elective unilateral THA surgery for osteoarthritis of the hip. The Activities-specific Balance Confidence Scale, Falls Risk in Older People in a Community Setting, Timed Up and Go Test, 30-Second Chair Stand Test, Step Test, …

The Standardization Of Outpatient Procedure (Stop) Narcotics: A Prospective Non-Inferiority Study To Reduce Opioid Use In Outpatient General Surgical Procedures, Luke B. Hartford

Electronic Thesis and Dissertation Repository

Surgeons play a significant role in the opioid crisis. A standardized, multipronged analgesia protocol was implemented with the objective of providing adequate analgesia while reducing opioids after outpatient breast and anorectal surgery.

A prospective, pre- and post-intervention study was designed to demonstrate non-inferiority for patient-reported post-operative pain. The intervention included patient and provider education, and multimodal perioperative analgesic strategies including opioid rescue prescriptions.

We evaluated 266 procedures. After implementation of the STOP Narcotics protocol, average post-operative pain scores in the post-intervention groups was non-inferior compared to the pre-intervention groups [(2.0 vs 2.1/10, p = 0.40, breast procedures) and (2.8 vs …

Understanding Transition Into Practice After Post Graduate Medical Education In Surgical Specialties, Mohammed M. Malak

Electronic Thesis and Dissertation Repository

Introduction: Becoming independent in the operating room is a source of tremendous stress in the initial years of practice. There is paucity of research describing the challenges surgeons face during transition and their coping strategies.

Methodology: We conducted semi-structured interviews using rich pictures as an elicitation method. Qualitative thematic analysis was used to analyze the data.

Results: Surgeons described their transition as revolving around two goals: achieving good outcomes and minimizing their fear of complications. They also described challenges related to being a surgeon and beyond being a surgeon. Contextual factors related to the surgical specialty played a pivotal role …

A Novel Minimally Invasive Tumour Localization Device, Doran Avivi

Electronic Thesis and Dissertation Repository

Lung cancer is one of the leading causes of death, by cancer. The usual treatment is surgical resection of tumours. However, patients who are weak or have poor pulmonary function are deemed unfit for surgery. For these patients, a minimally-invasive approach is desired. A major problem associated with minimally-invasive approaches is tumour localization in real time and accurate measurement of tool--tissue forces.

This thesis describes the design, analysis, manufacturing and validation of a minimally-invasive instrument for tumour localization, named Palpatron. The instrument has an end effector that is able to support two previously designed jaws, one containing an ultrasound sensor …

A Magnetic-Resonance-Imaging-Compatible Remote Catheter Navigation System., Mohammad Ali Tavallaei, Yogesh Thakur, Syed Haider, Maria Drangova

Medical Biophysics Publications

A remote catheter navigation system compatible with magnetic resonance imaging (MRI) has been developed to facilitate MRI-guided catheterization procedures. The interventionalist's conventional motions (axial motion and rotation) on an input catheter - acting as the master - are measured by a pair of optical encoders, and a custom embedded system relays the motions to a pair of ultrasonic motors. The ultrasonic motors drive the patient catheter (slave) within the MRI scanner, replicating the motion of the input catheter. The performance of the remote catheter navigation system was evaluated in terms of accuracy and delay of motion replication outside and within …

Molecular Imaging To Target Transplanted Muscle Progenitor Cells, Kelly Gutpell, Rebecca Mcgirr, Lisa Hoffman

Anatomy and Cell Biology Publications

Duchenne muscular dystrophy (DMD) is a severe genetic neuromuscular disorder that affects 1 in 3,500 boys, and is characterized by progressive muscle degeneration(1, 2). In patients, the ability of resident muscle satellite cells (SCs) to regenerate damaged myofibers becomes increasingly inefficient(4). Therefore, transplantation of muscle progenitor cells (MPCs)/myoblasts from healthy subjects is a promising therapeutic approach to DMD. A major limitation to the use of stem cell therapy, however, is a lack of reliable imaging technologies for long-term monitoring of implanted cells, and for evaluating its effectiveness. Here, we describe a non-invasive, real-time approach to evaluate the success of myoblast …

Errors In Device Localization In Mri Using Z-Frames., Jeremy Cepek, Blaine A Chronik, Aaron Fenster

Brain and Mind Institute Researchers' Publications

The use of a passive MRI-visible tracking frame is a common method of localizing devices in MRI space for MRI-guided procedures. One of the most common tracking frame designs found in the literature is the z-frame, as it allows six degree-of-freedom pose estimation using only a single image slice. Despite the popularity of this design, it is susceptible to errors in pose estimation due to various image distortion mechanisms in MRI. In this paper, the absolute error in using a z-frame to localize a tool in MRI is quantified over various positions of the z-frame relative to the MRI isocenter, …

Measurement Of Patient-Reported Outcomes In Surgical Orthopaedics, Kimberly Joy Neufeld

Digitized Theses

We examined the predictive relationship between factors previously shown to relate to patients’ ability to accurately recall past health states and discrepancies between pre- surgical (prospective) and post-surgical (retrospective) ratings of pre-intervention health status.

We used the least squares method of multiple linear regression to construct models that used the absolute and simple differences between pre-surgical and post-surgical ratings of physical health, mental health, function, and quality of life as dependent variables.

Four hundred and eleven patients were included in the analyses. Individually and in combination, the selected factors explained a limited amount of variance in the absolute and simple …

Virtual Reality Simulation For Myringotomy Training, Brian Burton Wheeler

Digitized Theses

A Virtual reality simulator has been developed with the purpose of training otolaryngology residents to perform myringotomy. For input, we used a stereo optical tracking device. This device allows for the tracking of surgical tool and anatomy positions in real time. For the output of the device, we designed a simulated microscope. This contains a stereo display for viewing the simulated environment. All processing such as physics calculations and graphical rendering are done in the system using an amalgamation of software tools. These hardware and software tools have been combined together to create a cohesive training simulator. After the design …

Treatment Patterns For Cancer In Western Australia: Does Being Indigenous Make A Difference?, Sonja E. Hall, Caroline E. Bulsara, Max K. Bulsara, Timothy G. Leahy, Margaret R. Culbong, Delia Hendrie, C D'Arcy J. Holman

Aboriginal Policy Research Consortium International (APRCi)

Objective: To examine whether hospital patients with cancer who were identified as Indigenous were as likely to receive surgery for the cancer as non-Indigenous patients. Design, setting and patients: Epidemiological survey of all Western Australian (WA) patients who had a cancer registration in the state-based WA Record Linkage Project that mentioned cancer of the breast (1982–2000) or cancer of the lung or prostate (1982–2001).

Main outcome measures: The likelihoods of receiving breast-conserving surgery or mastectomy for breast cancer, lung surgery for lung cancer, or radical or non-radical prostatectomy for prostate cancer were compared between the Indigenous and non-Indigenous populations using …

Volume 38, Index, Canadian Medical Association

Canadian Journal of Surgery

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.

Visit the journal website at http://canjsurg.ca/ for more.

Volume 38, Issue 6, Canadian Medical Association

Canadian Journal of Surgery

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.

Visit the journal website at http://canjsurg.ca/ for more.

Volume 38, Issue 5, Canadian Medical Association

Canadian Journal of Surgery

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.

Visit the journal website at http://canjsurg.ca/ for more.

Volume 38, Issue 4 Abstracts, Canadian Medical Association

Canadian Journal of Surgery

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.

Visit the journal website at http://canjsurg.ca/ for more.

Volume 38, Issue 4, Canadian Medical Association

Canadian Journal of Surgery

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.

Visit the journal website at http://canjsurg.ca/ for more.

Volume 38, Issue 3, Canadian Medical Association

Canadian Journal of Surgery

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.

Visit the journal website at http://canjsurg.ca/ for more.

Volume 38, Issue 2, Canadian Medical Association

Canadian Journal of Surgery

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.

Visit the journal website at http://canjsurg.ca/ for more.

Volume 38, Issue 1, Canadian Medical Association

Canadian Journal of Surgery

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.

Visit the journal website at http://canjsurg.ca/ for more.

Volume 37, Index, Canadian Medical Association

Canadian Journal of Surgery

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.

Visit the journal website at http://canjsurg.ca/ for more.

Volume 37, Issue 6, Canadian Medical Association

Canadian Journal of Surgery

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.

Visit the journal website at http://canjsurg.ca/ for more.

Volume 37, Issue 5, Canadian Medical Association

Canadian Journal of Surgery

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.

Visit the journal website at http://canjsurg.ca/ for more.

Volume 37, Issue 4, Canadian Medical Association

Canadian Journal of Surgery

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.

Visit the journal website at http://canjsurg.ca/ for more.

Volume 37, Issue 3, Canadian Medical Association

Canadian Journal of Surgery

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.

Visit the journal website at http://canjsurg.ca/ for more.

Volume 37, Issue 2, Canadian Medical Association

Canadian Journal of Surgery

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.

Visit the journal website at http://canjsurg.ca/ for more.

Volume 37, Issue 1, Canadian Medical Association

Canadian Journal of Surgery

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.

Visit the journal website at http://canjsurg.ca/ for more.