Medical Specialties Commons^™

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 …

Comparison Of Hip Navigation System Accuracy In Direct Anterior Approach, Jeremy Loh

Electronic Thesis and Dissertation Repository

Introduction

Malposition of the acetabular component has been thought to have an influence on increasing increase the risk instability, impingement, and ultimately revision surgery. Hip navigation technology has been developed to provide the surgeon with real time intraoperative metrics to make critical decisions in implant placement. The goal of this study was to compare the accuracy of acetabular component positioning in direct anterior approach hip replacements using conventional fluoroscopy only technique, fluoroscopic image dependent navigation, and imageless navigation.

Methods

A retrospective data collection and prospective analysis was conducted for this study. After sample size calculations, fifty patients were collected for …

A Long-Term Follow-Up Of The Stability Study: Multicenter Rct Comparing Anterior Cruciate Ligament Reconstruction With And Without Lateral Extra-Articular Tenodesis In Individuals At High Risk Of Graft Failure, Katelyn M. Inch

Electronic Thesis and Dissertation Repository

One hundred and ninety-six patients at the Fowler Kennedy Sport Medicine Clinic (FKSMC) undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) were randomized as part of the multi-center STABILITY study to receive either an isolated ACLR or ACLR with a lateral extra-articular tenodesis (LET). The STABILITY study followed these patients up to two years postoperative, and a long-term follow-up protocol was initiated afterwards. Eighty-two patients from this center were seen at three, five and seven years postoperative as part of a long-term follow-up. Our primary outcome was a composite outcome of instability and graft failure. Secondary outcomes included patient-reported outcome measures …

Total Hip Arthroplasty In Young Patients, Aaron G. Chen

Electronic Thesis and Dissertation Repository

Total hip arthroplasty (THA) is the gold standard in treatment of hip arthritis yet is often avoided in young patients due to concerns of inferior survivorship. We aim to explore the role of THA in young patients and assess whether these historical concerns are valid in contemporary THA by presenting the results of: (1) a systematic review and meta-analysis of the current literature, (2) a retrospective database review, and (3) a retrospective population-based study. We found excellent long-term survivorship with modern THA in young patients, demonstrating greater than 90% revision-free survival up to 15 years. Factors that may increase risk …

The Molecular Landscape Of Early-Stage Breast Cancer With Lymph Node Metastasis, Farhad Ghasemi

Electronic Thesis and Dissertation Repository

Axillary lymph nodes (ALNs) are the primary site of metastasis in breast cancer, and their involvement has implications in disease staging, prognostication, and treatment decisions. A non-invasive modality of assessing the risk of ALN metastasis can improve care in patients with early-stage breast cancer by omitting the morbidity and costs associated with axillary surgery.

This thesis explores the molecular landscape of early-stage breast cancers with ALN metastasis and shows the potential of tumour molecular signatures in predicting ALN involvement. After a systematic review of the literature, we use data from The Cancer Genome Atlas (TCGA) to develop molecular signatures correlated …

Feasibility And Clinical Value Of 3-Dimensional Myocardial Deformation Analysis By Computed Tomography In Transcatheter Aortic Valve Replacement Patients, Mohamad Rabbani

Electronic Thesis and Dissertation Repository

Purpose: Multi-phase computed tomography angiography (CTA) for the pre-procedural planning of TAVR presents a unique opportunity to assess 3D myocardial biomechanics. This study aimed to assess the feasibility and predictive utility of 3D myocardial deformation analysis (3D-MDA) based principal strain to predict heart failure or death following TAVR using pre-procedural, multi-phase computed tomography angiography (CTA) datasets.

Methods: Two hundred and five patients undergoing pre-TAVR multi-phase gated CTA followed by successful TAVR were retrospectively identified. Whole heart 3D mesh chamber models were generated followed by 3D-MDA of the left ventricle (LV) to determine global LV minimum principal strain (minPS) for endocardial, …

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 …