Surgery Commons^™

Cobourg's Covid-19 Vaccination Effort: A Model Of Community Engagement For Crisis Response, Sayra Cristancho, Emily Field, Crystal Gaudet

Surgery Publications

For many community members, emergency planning occurs in the background. Community members are not usually engaged in the planning activities. But people see the effects of planning when an emergency strikes. And when responses don’t appear to be happening or appear slow, empowered communities take charge. That’s what happened in Cobourg, Ontario between 2021 and 2022 when the community drove the implementation of the Covid-19 mass vaccination clinic at the Cobourg Community Centre, known as the CCC initiative. In this report, we synthesize the results of a qualitative assessment of the CCC clinic, including lessons and recommendations that other communities …

A Simple Perfused Cadaver Model For Damage Control Vascular Surgery Training, Shane A. Smith, Vivian C. Mcalister O.C.

Surgery Publications

No abstract provided.

Interpreting Patient Reported Outcomes In Orthopaedic Surgery: A Systematic Review, Shgufta Docter, Zina Fathalla, Michael Lukacs, Michaela Khan, Morgan Jennings, Shu-Hsuan Liu, Dong Zi, Dianne Bryant

Western Research Forum

Background: Reporting methods of patient reported outcome measures (PROMs) vary in orthopaedic surgery literature. While most studies report statistical significance, the interpretation of results would be improved if authors reported confidence intervals (CIs), the minimally clinically important difference (MCID), and number needed to treat (NNT).

Objective: To assess the quality and interpretability of reporting the results of PROMs. To evaluate reporting, we will assess the proportion of studies that reported (1) 95% CIs, (2) MCID, and (3) NNT. To evaluate interpretation, we will assess the proportion of studies that discussed results using the MCID or the effect sizes and how …

Perioperative Gait Analysis After Total Hip Arthroplasty: Does Outpatient Surgery Compromise Patient Outcomes?, Bryn O. Zomar, Susan W. Hunter, Dianne Bryant, Brent A. Lanting, James L. Howard

Western Research Forum

Background: There has been a continuing trend towards decreasing the length of hospital stay for patients undergoing total hip arthroplasty (THA). Outpatient procedures, discharging patients on the same day as surgery, have now become possible yet little research has been done to examine the impact this might have on patients during early recovery. We aimed to investigate the impact of discharge time on gait and patient-reported outcomes in the early post-operative period.

Methods: We measured gait velocity, stride length, single-limb support and single-limb support symmetry preoperatively, at discharge from the hospital, and two-, six- and 12-weeks postoperatively. Participants also completed …

An Intra-Bone Axial Load Transducer: Development And Validation In An In-Vitro Radius Model, Nikolas K. Knowles, Michael Gladwell, Louis M. Ferreira

Surgery Publications

Background

Accurate measurement of forces through the proximal radius can assess the effects of some surgical procedures on radioulnar load sharing, but is difficult to achieve given the redundant loading nature of the musculoskeletal system. Previously reported devices have relied on indirect measurements that may alter articular joint location and function. An axial load transducer interposed in the diaphysis of the radius may accurately quantify unknown axial loads of the proximal radius, and maintain articular location.

Methods

An in-vitro radius model was developed by interposing an axial load transducer in the diaphysis of the proximal radius. Static loads of 20, …

Renal Oncocytosis In A Pediatric Patient: Case Report And Review Of The Literature, Stacey Speer, Daniele Wiseman, Madeleine Moussa, Andreana Bütter

Surgery Publications

Renal oncocytosis is a rare condition in which the kidney develops numerous oncocytomas. We present a case of a 12-year-old female who presented with right-sided flank pain of one-year duration. Imaging revealed several masses in the right kidney. Tissue biopsy confirmed multiple benign oncocytomas. Due to the presence of multiple oncocytomas throughout the kidney, a radical nephrectomy was performed. Given the rarity of this condition, as well as its known association with von Hippel-Lindau disease and Birt-Hogg-Dube syndrome, genetic investigations were pursued but failed to identify any abnormalities. This patient remains well and disease free six years after surgery. A …

Pulmonary Sequestration Causing Severe Cardiac Failure Requiring Lobectomy In An Extreme Preterm Infant, Rohit Nagar, Andreana Bütter, Gary Brahm, April Price

Surgery Publications

We report a case of a large, extralobar pulmonary sequestration in a preterm infant born at 25 weeks gestational age. A computed tomography (CT) angiogram demonstrated that the arterial supply arose from the celiac trunk while an abnormally large, single left pulmonary vein drained the sequestration. This, along with the large patent ductus arteriosus (PDA), created a double left to right shunt, which resulted in severe, high output cardiac failure. Despite aggressive medical management for 3 weeks, he remained critically ill and developed renal failure. Therefore, after multiple, extensive multi-disciplinary discussions with the family, resection was offered as the only …

Bmp4 And Lgl1 Are Down Regulated In An Ovine Model Of Congenital Diaphragmatic Hernia, Heather M A Emmerton-Coughlin, K Kathryn Martin, Jacky S S Chiu, Lin Zhao, Leslie A Scott, Timothy R H Regnault, Andreana Bütter

Surgery Publications

BACKGROUND/PURPOSE: The molecular pathophysiology of lung hypoplasia in congenital diaphragmatic hernia (CDH) remains poorly understood. The Wnt signaling pathway and downstream targets, such as bone morphogenetic proteins (BMP) 4 and other factors such as late gestation lung protein 1 (LGL1), are essential to normal lung development. Nitrofen-induced hypoplastic CDH rodent lungs demonstrate down regulation of the Wnt pathway including BMP4 and reduced LGL1 expression. The aim of the current study was to examine the molecular pathophysiology associated with a surgically induced CDH in an ovine model.

METHODS: Left thoracotomy was performed at 80 days in 14 fetal sheep; CDH was …

Treatment Of Rectal War Wounds, O Van Waes, J Halm, J Vermeulen, Vivian Mcalister

Data and Test Instruments

Treatment strategies for penetrating rectal injuries (PRI) in civilian settings are still not uniformly agreed, in part since high-energy transfer PRI, such as is frequently seen in military settings, are not taken into account. Here, we describe three cases of PRI, treated in a deployed combat environment, and outline the management strategies successfully employed. We also discuss the literature regarding PRI management. Where there is a major soft tissue component, repetitive debridement and vacuum therapy is useful. A loop or end colostomy should be used, depending on the degree of damage to the anal sphincter complex.

Reuse Of Liver Grafts Following Brain Death Of The Initial Recipient, Hideaki Tanaka, Vivian Mcalister, Mark Levstik, Cameron Ghent, Paul Marotta, Douglas Quan, William Wall

Data and Test Instruments

AIM: To determine if there is a reasonable prospect of success of a re-use liver transplantation. METHODS: We systematically searched for reports of liver graft re-use using electronic searches of PubMed and Web of Knowledge. We performed hand searches of references lists of articles reporting re-use of grafts. RESULTS:A systematic review of the literature reveals 28 liver transplantations using previously transplanted grafts. First and second recipients ranged in age from 4 to 72 years and 29 to 62 years respectively. Liver disease in the first recipient was varied including 5 (18%) patients with fulminant liver failure who died subsequently of …

Absence Of The Genicular Arterial Anastomosis As Generally Depicted In Textbooks., Maher Sabalbal, Marjorie Johnson, Vivian Mcalister

Data and Test Instruments

This article reviews the history of anatomical research, starting with John Hunter and Astley Cooper, into the arterial anastomosis at the knee and uses dissection to determine the reality. The final draft is available below. (Ann R Coll Surg Engl. 2013 Sep;95(6):405-9) INTRODUCTION Textbook representations of the genicular arterial anastomosis show a large direct communication between the descending branch of the lateral circumflex femoral artery (DBLCFA) and a genicular branch of the popliteal artery but this is not compatible with clinical experience. The aim of this study was to determine whether the arterial anastomosis at the knee is sufficient, in …

Debate At The Royal College Summit On The Future Of General Surgery

Data and Test Instruments

Royal College of Physicians and Surgeons of Canada Task Force to address the Future of General Surgery, in Ottawa 13 May 2013: Dr Vivian McAlister debating with Dr Bill Pollett

Slow Birth Of New-Wave Medical Journalism, Vivian Mcalister

Data and Test Instruments

Half a century has passed since Sir Theodore Fox reflected upon his recently completed 40-year tenure as editor of The Lancet. He titled his farewell lecture series “Crisis in communication: the functions and future of medical journals.”1 Even though the number of journals had dramatically increased by the 1960s, submissions had proliferated to such an extent that Fox’s principal regret was the increasing fraction he was forced to refuse. In the late 19th century, the surgeon general of the United States was able to catalogue the entire body of medical knowledge up to that time in a volume that would …

Supporting Rebuilding Efforts In Afghanistan, Dialogue

Data and Test Instruments

The Royal College has been quietly assisting in the reconstruction of Afghanistan’s residency education system, devastated by years of war, by supplying members of the NATO Training Mission-Afghanistan (NTM-A) with educational materials and advice to appropriately modernize the country’s training programs.“These efforts are essential for the training of Afghan physicians in medical and surgical specialties, to ensure a healthy future for the people of Afghanistan,” says Major Vivian McAlister, MD, FRCSC, member of Royal College Council and NTM-A participant.The capacity-building initiative is supported on the ground by the NTM-A team, which includes numerous Fellows of the Royal College, who advise …

Civilian Trauma Care - Learning From The Military Experience, Vivian Mcalister

Data and Test Instruments

In the 21st century, military and civilian trauma surgeons bring similar solutions to similar problems, learning one from another. The objective of this presentation is to review military trauma care in Afghanistan for aspects that may influence civilian practice at home. • Comprehensive trauma care system: guidelines, registry, review • Protocols for care: damage control; massive blood transfusion policy; mass casualty care • Techniques: resuscitative thoracotomy; decompressive craniectomy; pelvic-gluteal hemorrhage control • Rehabilitation: Mild traumatic brain injury • Delegated medical acts: medics / PAs

Psoas Abscess - A Teaching File, Adina Feinberg, Vivian Mcalister

Data and Test Instruments

Case Report: A 43-year-old woman presented to the emergency room at University Hospital, London Health Sciences Centre with an eight-day history of lower back pain. She had presented one-week prior with similar symptoms and was treated conservatively for sciatica. Since then, her pain had progressively increased

The Life Of John Wishart (1850-1926): Study Of An Academic Surgical Career Prior To The Flexner Report., Emily Claydon, Vivian Mcalister

Data and Test Instruments

BACKGROUND: The 1910 Flexner Report on Medical Education in the United States and Canada is often taken as the point when medical schools in North America took on their modern form. However, many fundamental advances in surgery, such as anesthesia and asepsis, predated the report by decades. To understand the contribution of educators in this earlier period, we investigated the forgotten career of John Wishart, founding Professor of Surgery at Western University, London Ontario. METHODS: Archives at the University of Western Ontario, University of Toronto, London City Library, and Wellington County Museum were searched for material about Wishart and his …

Causes Of Death In Canadian Forces Members Deployed To Afghanistan And Implications On Tactical Combat Casualty Care Provision., D Pannell, R Brisebois, M Talbot, V Trottier, J Clement, N Garraway, Vivian Mcalister, H Tien

Data and Test Instruments

BACKGROUND: As part of its contribution to the Global War on Terror and North Atlantic Treaty Organization's International Security Assistance Force, the Canadian Forces deployed to Kandahar, Afghanistan, in 2006. We have studied the causes of deaths sustained by the Canadian Forces during the first 28 months of this mission. The purpose of this study was to identify potential areas for improving battlefield trauma care. METHODS: We analyzed autopsy reports of Canadian soldiers killed in Afghanistan between January 2006 and April 2008. Demographic characteristics, injury data, location of death within the chain of evacuation, and cause of death were determined. …

The Role 3 Multinational Medical Unit At Kandahar Airfield 2005-2010., R Brisebois, P Hennecke, R Kao, Vivian Mcalister, J Po, R Stiegelmar, H Tien

Data and Test Instruments

In late 2005, Canadian Forces Health Services (CFHS) was tasked with the command of the NATO Role 3 Multinational Medical Unit (R3MMU) on Kandahar Airfield in southern Afghanistan. Preparations drew on past experience and planning. Eight complete hospital contingents were trained and deployed in rotation. Near-reality simulation training was undertaken with the combat brigade, including complete deployment of the field hospital in the exercise area. Standard operating procedures (SOP) were developed and applied by each rotation so successfully that they were adopted by the new command in late 2009. The Canadian period at R3MMU had the highest survival rate ever …

Utilization Profile Of The Trauma Intensive Care Unit At The Role 3 Multinational Medical Init At Kandahar Airfield Between May 1 And Oct. 15, 2009., Sha K, Pirie S, Compton L, Vivian Mcalister, Brian Church, Ray Kao

Data and Test Instruments

Background: In the war against the Taliban, Canada was the lead North Atlantic Treaty Organization (NATO) nation to provide medical and surgical care to NATO soldiers, Afghanistan National Army soldiers, Afghanistan Nation Police, civilians working in and outside Kandahar Airfield and Afghanistan civilians at the Role 3 Multinational Medical Unit (R3MMU) from February 2006 to October 2009. Methods: We obtained data from the Joint Theatre Trauma Registry between May 1 and Oct. 15, 2009; 188 patients were admitted to the R3MMU intensive care unit (ICU). We analyzed the ICU data according to types and causes of trauma, mechanical ventilation prevalence, …

Principles Of Combat Surgical Care In A Staged Evacuation System, Vivian Mcalister, Rob Stiegelmar, Brian Church, Ray Kao

Data and Test Instruments

Background: The NATO hospital classification of hospitals describes an orderly transfer of patients with severe injuries through a series of increasingly sophisticated hospitals as they are brought from the point of injury to their home hospital. Forward hospital surgery is restricted to damage control and resuscitation while definitive surgery is performed at home by the destination surgical team. In reality many patients enter the hospital chain higher up and some receive definitive surgery as they proceed through the chain of evacuation. The purpose of this paper is to determine if clear doctrine exists to guide the performance of surgery on …

The Role Of Surgery In Building Resilience To Blast Attacks, Vivian Mcalister

Data and Test Instruments

Blast attacks are the commonest form of terrorist attack on civilians. Blast often causes injury from industrial accidents. Blast injury is the most common cause of injury and death in modern combat. A recent review of Canadian fatal casualties in Afghanistan found 81% to have been caused by blast, almost four times the number killed by gun shot wounds. Improvised explosive devices (IED) caused 78% of the blasts with another 20% being due to rocket propelled grenades (RPG).1 The purpose of this review is to outline the mechanisms of injury, to define the surgical response and to understand the implications …

A Comparison Of Two Headless Compression Screws For Operative Treatment Of Scaphoid Fractures, Ruby Grewal, Joseph Assini, David Sauder, Louis Ferreira, Jim Johnson, Kenneth Faber

Surgery Publications

PURPOSE: The purpose of this study was to compare the interfragmentary compression force across a simulated scaphoid fracture by two commonly used compression screw systems; the Acutrak 2 Standard and the 3.0 mm Synthes headless compression screw.

METHODS: Sixteen (8 pairs; 6 female, 2 male) cadaver scaphoids were randomly assigned to receive either the Acutrak 2 or Synthes screw with the contralateral scaphoid designated to receive the opposite. Guide wires were inserted under fluoroscopic control. Following transverse osteotomy, the distal and proximal fragments were placed on either side of a custom load cell, to measure interfragmentary compression. Screws were placed …

Mass Casualty Training Exercise At The Canadian Surgery Forum

Data and Test Instruments

On September 18, 2011 second year Schulich School of Medicine and Dentistry students helped run the first mass casualty training exercise, directed by Dr. Vivian McAlister, Division of General Surgery, at the Canadian Surgery Forum held this year at the London Convention Centre.

Composite Tissue Allotransplantation To Treat Veterans With Complex Amputation Injuries, Vivian Mcalister, Ray Kao, Brian Church, Markus Besemann, Rob Stiegelmar

Data and Test Instruments

Amputee rehabilitation may be limited by complexity of injury (e.g. bilateral arm amputation), associated injury (e.g. colostomy) or by the level of amputation (e.g. high above knee). Our objective is to assess the potential for composite tissue allotransplantation (CTA) to overcome these barriers. Medical literature was searched and programs were surveyed regarding the current status of CTA. Results CTA remains an experimental reconstructive option that involves a large collaborative (physiatry, orthopaedic, plastic and transplant surgeons). Limb transplantation has evolved out of limb reimplantation surgery and organ transplantation. Approximately 10 programs world wide, with almost a decade of experience, report 90% …

Do Older Patients Utilize Excess Health Care Resources After Liver Transplantation?, Neil Shankar, Mamoon Albashir, Paul Marotta, William Wall, Vivian Mcalister, Natasha Chandok

Data and Test Instruments

INTRODUCTION: Liver transplantation is a highly effective treatment for end-stage liver disease. However, there is debate over the practice of liver transplantation in older recipients (age ≥ 60 years) given the relative shortage of donor grafts, worse post-transplantation survival, and concern that that older patients may utilize excess resources postoperatively, thus threatening the economic feasibility of the procedure. AIM: To determine if patients ≥ 60 years of age utilize more health resources following liver transplantation compared with younger patients. MATERIAL AND METHODS: Consecutive adult patients who underwent primary liver transplantation (n = 208) at a single center were studied over …

Review Of “Noted Surgeon, Fine Citizen”: The Life Of Archibald E Malloch, Md 1844–1919 By Charles G. Roland, Chloe Mcalister, Vivian Mcalister

Data and Test Instruments

No abstract provided.

2010 Newsmakers: Celebrating Our Own, Paul Mayne, Jason Winders

Data and Test Instruments

How will we remember 2010? Probably through these faces. This year, the Western News starts a new, if not wholly original, tradition. Our Newsmakers 2010 section celebrates the best of research, academia and volunteer spirit that we have to offer on this campus. We spotlight, in brief words and striking images, the accomplishments of some of our favourites from the last year. One of the most powerful women in Canada. A student with an eye for the greater good. And a man who would do anything, including posing with a zebra, for the United Way. A football coach. A ground-breaking …

A Pioneer Of Urologic Surgery From A Small Town In Ontario, Canada: A Tribute To Abraham Groves (1847-1935)., Yves Caumartin, Vivian Mcalister, Patrick Luke

Data and Test Instruments

Background: Abraham Groves worked as a general practitioner and surgeon in the small town of Fergus, Ontario, Canada. Several priority claims have been attributed to Groves’ life in surgery, including aseptic surgery (1874), appendectomy (1883) and the use of surgical gloves (1885). He was also an early practitioner of urological surgery. Objective: The purpose of this paper is to describe and objectively assess his contributions as a pioneer in urological surgery. Methods: A systematic search of contemporary journals was made for articles by or about Groves. These articles and his 1934 autobiography were reviewed. The information was assessed not only …

Western News: Rewriting The Record On Legs, Lesley Craig, Paul Mayne

Data and Test Instruments

No abstract provided.