Search

Serous ovarian cancer is the most common subtype of epithelial ovarian carcinoma-the most prevalent type of ovarian cancer. High-grade serous ovarian carcinoma (HGSOC) is thought to arise from the distal fallopian tube, with a precursor lesion known as serous tubal intraepithelial carcinoma (STIC). STICs are found in the final pathology of a salpingectomy specimen in 10%-20% of women with a BRCA gene mutation and 1%-7% of women without a mutation. However, there is currently no official guideline and a paucity of data on the management of STICs.We performed a systematic review following PRISMA guidelines. Five databases were searched for relevant studies on STICs.Two independent reviewers performed the abstract and full-text screening and data extraction, with conflicts resolved through discussion with the third reviewer. The risk of bias of each study was assessed using the Newcastle-Ottawa scale.Fourteen articles were included. Ninety-nine patients who were diagnosed with STIC and subsequently followed for a mean period of 55.5 months were included in this analysis. Eighty-three patients (83.9%) were BRCA mutation carriers. After the diagnosis of isolated STIC, 7 patients (7.3%) received chemotherapy and 25 (26%) underwent surgical staging. Three of the 25 patients were diagnosed with HGSOC based on the staging surgery. Nine patients were later diagnosed with HGSOC during follow-up, with an average duration of follow-up of 58.5 months between the diagnosis of STIC and the diagnosis of HGSOC.Based on our review of the literature, there is a 10.7% risk of having concurrent HGSOC at the time of STIC diagnosis, and the risk of developing a subsequent HGSOC is 14.5%. BRCA mutation status should be determined in cases of isolated STIC, as 83.9% of patients included in this study were found to carry BRCA mutations. We believe it is necessary to further investigate the role of surgical staging following the diagnosis of STIC.

Cervical sagittal alignment is correlated with myelopathy severity and used by spinal surgeons for surgical planification. Magnetic resonance imaging (MRI) is the gold standard for the evaluation of cervical myelopathy but may not be for the assessment of cervical sagittal balance compared to X-rays. The objective of this study was to assess the correlation of cervical alignment between supine MRI and standing radiographs in patients with cervical spondylotic myelopathy (CSM). Cobb, Jackson and Harrison methods were used to measure cervical sagittal alignment on supine MRI and standing radiographs of CSM adults. Cervical alignment was divided based on Cobb angle values on lordotic (> 4°), kyphotic (

Resume Objectifs L'objectif principal est de determiner la strategie publicitaire presentant le meilleur rapport cout-benefice dans le cadre de la Semaine nationale de sensibilisation au cancer du col de l'uterus. Les objectifs secondaires sont de determiner les raisons pour lesquelles les femmes n'ont pas subi de test de depistage en premiere ligne et le nombre de resultats cytologiques anormaux issus de la semaine de sensibilisation. Methodologie Dans le cadre d'un projet de qualite de l'acte, nous avons examine tous les dossiers de patientes d'un centre hospitalier universitaire ayant subi un depistage du cancer du col de l'uterus durant la semaine nationale de prevention du cancer du col. Resultats Durant la semaine de prevention d'octobre 2018, 202 femmes ont subi un test de depistage. Chez 180 d'entre elles, il a ete possible d'obtenir de l'information sur les strategies publicitaires qui les ont incitees a participer a l’evenement ainsi que sur leur suivi en premiere ligne. Les moyens publicitaires gratuits (y compris le site Web Facebook et un reportage televise) ont incite 66 femmes a participer (36,7 %), ce qui represente le moyen publicitaire presentant le meilleur rapport cout-benefice. Parmi les participantes, 59 % avaient un medecin de famille, mais 41 % d'entre elles nous ont mentionne que leur medecin de famille ne pratiquait pas d'examen gynecologique. Par ailleurs, 2,8 % des femmes ayant subi un test de depistage ont eu des resultats cytologiques anormaux. Conclusion Ce sont les moyens publicitaires gratuits qui ont ete les plus efficients au terme de la semaine de sensibilisation. La majorite des participantes avaient deja acces a un medecin famille. Des activites de sensibilisation au cancer du col doivent continuer a avoir lieu afin d'augmenter les taux de depistage et des strategies doivent etre mises en place afin d'ameliorer l'acces au test Pap.

Anemia is common in critically ill patients with traumatic brain injury, and often requires red blood cell transfusion. Studies suggest that prolonged storage causes lesions of the red blood cells, including a decreased ability to carry oxygen. Considering the susceptibility of the brain to hypoxemia, victims of traumatic brain injury may thus be more vulnerable to exposure to older red blood cells. Our study aimed to ascertain whether the administration of fresh red blood cells (seven days or less) results in a better neurologic outcome compared with standard red blood cells in critically ill patients with traumatic brain injury requiring transfusion. The Age of Blood Evaluation in traumatic brain injury (ABLE-tbi) study was a nested study within the ABLE study (ISRCTN44878718). Our primary outcome was the extended Glasgow Outcome Scale (GOSe) at six months. In the ABLE study, 217 subjects suffered a traumatic brain injury: 110 in the fresh group, and 107 in the standard group. In the fresh group, 68 (73.1%) of the patients had an unfavourable neurologic outcome (GOSe ≤ 4) compared with 60 (64.5%) in the standard group (P = 0.21). Using a sliding dichotomy approach, we observed no overall effect of fresh red blood cells on neurologic outcome (odds ratio [OR], 1.34; 95% confidence interval [CI], 0.72 to 2.50; P = 0.35) but observed differences across prognostic bands with a decreased odds of unfavourable outcome in patients with the best prognosis at baseline (OR, 0.33; 95% CI, 0.11 to 0.96; P = 0.04) but an increased odds in those with intermediate and worst baseline prognosis (OR, 5.88; 95% CI,1.66 to 20.81; P = 0.006; and OR, 1.67; 95% CI, 0.53 to 5.30; P = 0.38, respectively). Overall, transfusion of fresh red blood cells was not associated with a better neurologic outcome at six months in critically ill patients with traumatic brain injury. Nevertheless, we cannot exclude a differential effect according to the patient baseline prognosis. ABLE study (ISRCTN44878718); registered 22 August, 2008.

Resume Objectif La Societe des obstetriciens et gynecologues du Canada (SOGC) et la Societe de gyneco-oncologie du Canada (GOC) recommandent d'offrir l'exerese complete des trompes uterines comme moyen de contraception permanente en raison de la diminution du risque du cancer de l'ovaire. Or, a l'heure actuelle, bon nombre de femmes ne se font pas offrir la salpingectomie bilaterale en remplacement de la ligature des trompes comme moyen de contraception permanente. Methode Dans le cadre d'un projet d’evaluation de la qualite, tous les cas de sterilisation realises dans un centre universitaire du 1er janvier au 31 decembre 2018 ont ete analyses. Une revue de la litterature entourant les considerations cliniques et ethiques qui empechent les cliniciens d'offrir la salpingectomie bilaterale en guise de contraception permanente est aussi presentee. Resultats Les dossiers de 111 femmes ayant subi une sterilisation tubaire ont ete etudies. Parmi celles-ci, 31,5 % ont subi une salpingectomie bilaterale; 46,8 %, une fulguration des trompes; 12,6 %, une ligature par clips; et 9,1 %, une ligature par implants tubaires (Essure). Selon la documentation au dossier, seulement 36,3 % des femmes s’etaient fait proposer une salpingectomie bilaterale; de ce nombre, 83,8 % ont choisi cette methode. Conclusion La salpingectomie bilaterale devrait etre offerte a toutes les femmes qui consultent pour une sterilisation. Les avantages et les tres faibles risques de cette intervention en font une option de premier choix.

Objective:To comprehensively assess recurrent traumatic brain injury (rTBI) risk and risk factors in the general population.Methods:We systematically searched MEDLINE, EMBASE, and the references of included studies until January 16, 2017, for general population observational studies reporting rTBI risk or risk factors. Estimates were not meta-analyzed due to significant methodologic heterogeneity between studies, which was evaluated using meta-regression.Results:Twenty-two studies reported recurrence risk and 11 reported on 27 potential risk factors. rTBI risk was heterogeneous and varied from 0.43% (95% confidence interval [CI] 0.19%–0.67%) to 41.92% (95% CI 34.43%–49.40%), with varying follow-up periods (3 days–55 years). Median time to recurrence ranged from 0.5 to 3.8 years. In studies where cases were ascertained from multiple points of care, at least 5.50% (95% CI 4.80%–6.30%) of patients experienced a recurrence after a 1-year follow-up. Studies that used administrative data/self-report surveys to ascertain cases tended to report higher risk. Risk factors measured at time of index traumatic brain injury (TBI) that were significantly associated with rTBI in more than one study were male sex, prior TBI before index case, moderate or severe TBI, and alcohol intoxication. Risk factors reported in a single study that were significantly associated with rTBI were epilepsy, not seeking medical care, and multiple factors indicative of low socioeconomic status.Conclusions:rTBI is an important contributor to the general population TBI burden. Certain risk factors can help identify individuals at higher risk of these repeated injuries. However, higher quality research that improves on rTBI surveillance methodology is needed.

This article was migrated. The article was marked as recommended. Physician advocacy and leadership is increasingly recognized as an important part of our social responsibility. Frameworks, such as CanMEDS, have set out definitions of health advocacy and leadership for medical education. Despite calls for mandatory advocacy and leadership teaching and potential wellness benefits, presently medical curricula do not usually teach practical advocacy and leadership skills to learners. There is also a demonstrated disconnect between staff and resident perceptions of advocacy. Our group set out to create an innovative Advocacy and Leadership Curriculum (ALC) to fill this gap. A collaboration of over twenty medical students and professors from across Canada and the U.S worked over the past year to survey students, conduct curriculum mapping, examine current literature and practices in order to inform the creation of an ALC. A competency- and milestone-based ALC was created based on this data and reviewed by experts in medical education and/or physician advocacy. This ALC addresses three spheres of advocacy: the Patient level, the Institutional level, and the Population level (which includes the Community). A guiding principle of the ALC is to form positive working partnerships with communities and patients and to collaborate with other health professionals to advocate with, and on behalf of, patients. CanMEDS-based Learning Objectives, divided into theoretical, skills-based, and application-based categories, form the core of the program. The curriculum prepares learners for real-world advocacy through longitudinal projects, interdisciplinary work, and community-based service learning. Novel engagement of other professionals and physician advocates to act as advocacy preceptors is central to the curriculum. Innovative assessment techniques- such as advocacy simulations, longitudinal study of physician advocacy activity, and focus on attitudes and behaviour as well as knowledge and practical advocacy skills- are introduced. The ALC serves as an adaptable model for the training of socially responsible medical learners who are conversant in advocacy techniques and able to advocate with patients, within institutions, and with populations. Projects resulting from the ALC will improve medical school social accountability.