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The article discusses the significance of optimizing the language and format of clinical practice guidelines to improve guideline uptake, along with tips on how to increase guideline uptake. Topics discussed include reasons why clinicians do not use guidelines, the importance of language and format of guidelines, and ways to improve the intrinsic characteristics of guidelines. It also explores the challenge of poor uptake of guidelines across health systems.

Background: Discordant practice patterns may be a consequence of evidence-practice gaps or deficiencies in knowledge translation. We examined the current strategies used by hepato-pancreatico-biliary (HPB) surgeons in Canada for the perioperative management of pancreaticoduodenectomy (PD). Methods: We generated a web-based survey that focused on the perioperative measures surrounding PD. The survey was distributed to all members of the Canadian Hepato-Pancreatico-Biliary Association. Results: The survey was distributed to 74 surgeons and received a response rate of 50%. Many similarities in surgical techniques were reported; for example, most surgeons (86.5%) reconstruct the pancreas with pancreaticojejunostomy rather than pancreaticogastrostomy. In contrast, variable techniques regarding the use of peritoneal drainage tubes, anastomotic stents, octreotide and other intraoperative modalities were reported. Most surgeons (75.7%) reported that their patients frequently required preoperative biliary drainage, yet there was minimal agreement with the designated criteria. There was variability in postoperative care, including the use of epidural analgesia and timing of postoperative oral nutrition. Conclusion: We identified heterogeneity among Canadian HPB surgeons, suggesting a number of evidence-practice gaps within specific domains of pancreatic resections. Focused research in these areas may facilitate technical agreement and improve patient outcomes following PD. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic surgery has gained popularity over open conventional surgery as it offers benefits to both patients and health care practitioners. Although the overall risk of complications during laparoscopic surgery is recognized to be lower than during laparotomy, inadvertent serious complications still occur. Creation of the pneumoperitoneum and placement of laparoscopic ports remain a critical first step during endoscopic surgery. It is estimated that up to 50% of laparoscopic complications are entry-related, and most injury-related litigations are trocar-related. We sought to evaluate the current practice of laparoscopic entry among Canadian general surgeons. Methods: We conducted a national survey to identify general surgeon preferences for laparoscopic entry. Specifically, we sought to survey surgeons using the membership database from the Canadian Association of General Surgeons (CAGS) with regards to entry methods, access instruments, port insertion sites and patient safety profiles. Laparoscopic cholecystectomy was used as a representative general surgical procedure. Results: The survey was completed by 248 of 1000 (24.8%) registered members of CAGS. Respondents included both community and academic surgeons, with and without formal laparoscopic fellowship training. The demographic profile of respondents was consistent nationally. A substantial proportion of general surgeons (> 80%) prefer the open primary entry technique, use the Hasson trocar and cannula and favour the periumbilical port site, irrespective of patient weight or history of peritoneal adhesions. One-third of surgeons surveyed use Veress needle insufflation in their surgical practices. More than 50% of respondents witnessed complications related to primary laparoscopic trocar insertion. Conclusion: General surgeons in Canada use the open primary entry technique, with the Hasson trocar and cannula applied periumbilically to establish a pneumoperitoneum for laparoscopic surgery. This surgical approach is remarkably consistent nationally, although considerably variant across other surgical subspecialties. Peritoneal entry remains an important patient safety issue that requires ongoing evaluation and study to ensure translation into safe contemporary clinical practice. [ABSTRACT FROM AUTHOR]

Background: Ileal pouch anal anastomosis (IPAA) to surgically manage ulcerative colitis may involve multiple separate surgical procedures, impacting treatment costs, length of stay in hospital, complication rates and patient outcomes, and there is currently no accepted standard of care regarding the number of stages that should be performed. The purpose of this study was to compare the practice patterns of Canadian and American colorectal surgeons regarding the surgical management of ulcerative colitis. Methods: A questionnaire was mailed to all practisng fellows of the American Society of Colon and Rectal Surgeons (ASCRS) in Canada and the United States. Surgeons were asked to describe their typical practices for 3 clinical scenarios. Results: Questionnaires were mailed to 40 Canadian and 873 American ASCRS fellows with response rates of 86% and 62%, respectively. In the case of a patient who has had a prior colectomy, who is not taking steroids and in whom a tension-free IPAA is possible, 44% of Canadian surgeons would perform IPAA alone and 56% would perform IPAA with a loop ileostomy. In contrast, only 26% of American surgeons would perform IPAA alone and 74% would perform IPAA with a loop ileostomy (p = 0.002). In the case of a patient who has not had previous surgery, who is taking 10 mg/day of prednisone and in whom a tension-free IPAA is possible, the majority of both Canadian and American surgeons would perform an IPAA with a loop ileostomy (93% and 89%, respectively, p = 0.06). In the case of a patient who has not had previous surgery, who is taking 40 mg/day of prednisone and in whom a tension-free IPAA is possible, 45% of Canadian surgeons would perform a subtotal colectomy with an end ileostomy compared with 14% of American surgeons (p < 0.001). Conclusion: There are significant differences in the surgical management of ulcerative colitis between Canadian and American colorectal surgeons. [ABSTRACT FROM AUTHOR]

The article presents information on the 2006 clinical practice recommendations on the management and prevention of obesity in adults and children in Canada. It states that several key outcomes of interest were identified by the guidelines such as anthropometric, biochemical and psychosocial outcomes. It mentions that health care professionals can use these guidelines in their everyday clinical practice.

Background: A principal objective of the Canadian Clinical Practice Guidelines for the Care and Treatment of Breast Cancer was to reduce the variation in the way that breast cancer was being treated. To evaluate whether this goal has been reached, we examined variations among surgeons for 4 measures of surgical care and tested for differences in province-wide rates and in variations among surgeons before and after the guidelines were released. Methods: We studied a population-based cohort of 7022 women living in Manitoba in whom breast cancer was diagnosed from 1995 to 2003 inclusive. Demographic, tumour and treatment information was obtained from the Manitoba Cancer Registry. We examined 4 measures of care: breastconserving surgery, axillary assessment in invasive disease, axillary node dissection in noninvasive disease and the adequacy of axillary node dissection. Generalized linear models were used to test for significant variations in care among surgeons and to test for differences in province-wide rates and variations in these rates among surgeons before and after introduction of the guidelines. Results: We found clinically significant variations in the province-wide rates of all 4 measures examined. These variations were statistically significant for all measures except axillary node dissection in noninvasive disease. No significant differences in either the province-wide rates or in variations in these rates among surgeons before and after introduction of the guidelines were found for any of the measures. Interpretation: Our results suggest that the Canadian breast cancer guidelines are not meeting their stated objective. New strategies for guideline dissemination and implementation may be required. [ABSTRACT FROM AUTHOR]

Introduction: The Canadian Task Force on Preventive Health Care (CTF-PHC) recently revised its screening recommendations for colorectal cancer (CRC). We wished to assess the effect of this change on the screening beliefs and clinical practice of primary care physicians. Methods: We surveyed 160 primary-care physicians, quasi-randomly sampled, in June-July 2001 and again in April-July 2002, 9 months after publication of the guidelines. Descriptive statistics and McNemar χ2 analyses were carried out on data from physicians who responded to both surveys. Results: Of the those sampled, 47% responded to both surveys. After the publication of the CTF-PHC guidelines, the proportion reporting that they recommend CRC screening to their patients at average risk increased from 43% to 60% (p = 0.02). Before publication of the revised guidelines 48% stated that the CTF-PHC did not support screening, compared with 24% afterward (p = 0.01). CTF-PHC guidelines were acknowledged by 30% to be a source of CRC screening information. Around 9 months post-publication, 24% of the physiciansstated their awareness of the revised screening guidelines. The most commonly cited reasons for not recommending CRC screening to average-risk patients were that the evidence is inconclusive and thatCTF-PHC guidelines do not support screening. Conclusions: After publication of the revised CTFPHC guidelines more primary-care physicians reported that they recommend CRC screening to their average-risk patients. The belief that the evidence is inconclusive nevertheless remains a considerable barrier to implementation. To increase the use of screening for CRC, additional strategies are required. [ABSTRACT FROM AUTHOR]

Background Health systems planning is a challenging task, exacerbated by a lack of detailed information on the role played by family physicians, as indicated by practice variations across regions and demographic characteristics. Outcome measures used in past studies of family physician practice patterns were not uniform. Furthermore, past research has generally been limited to narrowly defined geographic regions. A national study of family physician practice patterns was undertaken to allow regional-level comparisons of clinical workload and range of medical services offered. Methods The 1997/98 National Family Physician Survey was mailed to a sample of 5198 Canadian family physicians and general practitioners (FP/GPs); the overall response rate was 58.4% (3036 questionnaires returned, of which 3004 were analyzable). Sampling strata were based on College of Family Physicians of Canada (CFPC) membership status and regions of Canada. Results Clinical workload varied considerably across the demographic categories studied. Male physicians reported 8.9 more total weekly work hours than female physicians, but the mean number of medical and clinical services offered did not differ between the sexes. Solo practitioners reported 53.8 (95% confidence interval [CI] 52.7-55.0) total weekly work hours, whereas those practising in multidisciplinary clinics reported 45.0 (95% CI 43.2-46.8) hours. FP/GPs in the Atlantic and Prairie provinces reported 5.6 and 5.1 more weekly work hours, respectively, than the national average of 51.4 (95% CI 50.8-52.0) hours. Finally, FP/GPs who served inner-city populations reported 48.6 (95% CI 46.8-50.5) total weekly work hours, whereas those serving rural populations reported 57.0 (95% CI 54.7-59.2) hours. Mean weekly work hours were similar for all age cohorts less than 65 years. FP/GPs practising in less populated provinces and in rural areas reported the highest numbers of work hours, medical services offered and clinical procedures... [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented in response to the article "Revalidation of physicians in Canada: Are we passing the test?" by Wendy Levinson.

The article highlights the willingness of Canadian to offer financial support for the development of clinical practice guidelines in 2011. According to Ontario Assistant Deputy Health Minister Vasanthi Srinivasan in her speech at the Canadian Clinical Practice Guidelines Summit, provincial governments like to assure patients get the most suitable quality of care. She adds that Canada has a window of opportunity to enforce a strategy for the implementation of clinical practice guidelines.

The article offers information on the wide variations in the quality of clinical practice guidelines in Canada in 2011. According to Dr. Sam Shortt of the Canadian Medical Association, many clinicians heavily rely on industry funding with no central source to coordinate guideline developers. Dr. Ian Graham of Canadian Institutes of Health Research, guideline developers fail to take into account how their suggestions may fare in the context to treat patients having multiple conditions.

The article provides information on Dr. Anne Doig, the new president of the Canadian Medical Association (CMA) in Canada. Doig said that as the new CMA president, her first priority will be to canvas the country's practicing doctors. The doctor stressed that most of the physicians in the country are not trying to undermine medicare.

The article reports on the disagreement among Canadian and international experts on the use of medical guidelines in informing primary health care decision-making in Canada. According to Dr. Janusz Kaczorowski, research director for the Department of Family Practice at the University of British Columbia in Vancouver says that opinions on the value of practice guidelines are strident. It states that primary health care providers are expected to be up to date but the information is unmanageable.

The article discusses the factors predicting the physician's choice of rural practice during medical school. The author presents that rural practice includes quality of life in a rural setting, mentor experiences and exposure to breadth of practice. A list of several programs providing access to electives in rural clinical training under the "Rural Experiences Access Program" (REAP) at various places in Canada is also presented.

Reports that Manitoba is considering posting online physician profiles which may include a record of outcomes of the treatment provided by doctors in the province. Recommendation of the profiles following an inquest into the deaths of a number of pediatric cardiac patients in Winnipeg; Expense and difficulty in compiling the outcomes records.

Addresses the issue of new medical technologies, and whether physicians are at risk when they do not offer them to patients. Expectation by Canadians that their doctor will disclose all available treatments; How a mock trial assisted a decision at the Toronto Vascular Surgery Symposium; Opinions by various members, including Justice Ellen Macdonald of Ontario that the government and hospitals were not liable.

Discusses the growth of Canada's population and the number of applicants to Canadian medical schools since 1976. Concern about a physician shortage; Enrollment and tuition fees; Types of students applying to medical schools; How female physicians affect the supply because of their practice patterns.