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Abstract Background Back pain is the leading cause of disability worldwide. Despite guidelines discouraging opioids as first-line treatment, opioids remain the most prescribed drugs for back pain. There is renewed interest in exploring the potential medical applications of cannabis, and with the recent changes in national legislation there is a unique opportunity to investigate the analgesic properties of cannabis. Methods This was a multi-center survey-based study examining patient perceptions regarding cannabis for spine pain. We included patients presenting with back or neck pain to one of three Orthopedic clinics in Ontario. Our primary outcome was perceived effect of cannabis on back pain, while secondary outcomes were perceptions regarding potential applications and barriers to cannabis use. Results 259 patients participated in this study, 35.3% (90/255) stating they used cannabis medically. Average pain severity was 6.5/10 ± 0.3 (95% CI 6.2–6.8). Nearly three-quarters were prescribed opioids (73.6%, 148/201), with oxycodone/oxycontin (45.9% 68/148) being the most common, and almost half of (49.3%, 73/148) had used an opioid in the last week. Patients estimated cannabis could treat 54.3% ± 4.0 (95% CI 50.3–58.3%) of their spine pain and replace 46.2% ± 6. 6 (95% CI 39.6–52.8%) of their current analgesics. Age (β = − 0.3, CI − 0.6–0.0), higher pain severity (β = 0.4, CI 0.1–0.6) and previous cannabis use (β = 14.7, CI 5.1–24.4) were associated with a higher perceived effect of cannabis. Patients thought cannabis would be beneficial to treat pain (129/146, 88.4%), and reduce (116/146, 79.5%) or eliminate opioids (102/146, 69.9%). Not considering using cannabis for medical purposes (65/150, 43.3%) was the number one reported barrier. Conclusions Patients estimated medical cannabis could treat more than half of their spine pain, with one in three patients already using medical cannabis. 79% of patients also believe cannabis could reduce opioid usage. This data will help support more research into cannabis for musculoskeletal pain.

Study objectiveThe objective of this study was to conduct a systematic review and meta-analysis of the diagnostic accuracy of the clinical signs, symptoms, laboratory investigations, and imaging modalities commonly used in patients with clinically suspected renal colic.MethodsWe conducted this systematic review and meta-analysis according to an a priori, registered protocol (PROSPERO CRD42017055153). A literature search was performed using MEDLINE and EMBASE from inception to July 2, 2020. We assessed the risk of bias using Quality Assessment of Diagnostic Accuracy Studies-2, calculated likelihood ratios (LRs), and applied a random-effects model for meta-analysis.ResultsAmong 7641 references screened, 76 were included in the systematic review and 53 were included in the meta-analyis. The overall pooled prevalence for ureteral stones was 63% (95% confidence interval [CI], 58%-67%). No individual demographic feature, symptom, or sign when present had an LR+ ≥2.0 for identifying ureterolithiasis. A (Sex, Timing and Origin of pain, race, presence or absence of Nausea, and Erythrocytes) STONE score ≥10 increased (sensitivity 0.49, specificity 0.91, LR 5.3 [95% CI, 4.1-6.7]) and a STONE score

Objective: To determine if there is an association between the timing of testosterone discontinuation and assisted reproductive technology (ART) outcomes. Design: Retrospectivse cohort study. Setting: Single academic center. Patient(s): We included consecutive transgender patients seeking fertility preservation between October 2019 and April 2021. Patients who identified as transgender on androgens for >1 month on presentation were included. Intervention(s): None. Main outcome measure(s): A linear regression model was used to evaluate the effect of testosterone discontinuation duration on the number of mature oocytes retrieved. Result(s): Eighteen patients (mean age 27.7 [SD 5.2] years, mean body mass index 27.3 [SD 4.6] kg/m2, mean antimüllerian hormone 27.2 [SD 11.8], median antral follicle count 20 [interquartile range (IQR) 14–32]) were included in the analysis. No patient underwent transition-related surgery (eg, oophorectomy, hysterectomy). None of the patients were previously pregnant. Mean time o,n testosterone was 44 (SD 29.6) months. The median time off testosterone until the start of ovarian stimulation was 7.7 weeks (IQR 4.3–20.7). All patients underwent oocyte cryopreservation except one who had embryo cryopreservation. The median total number of oocytes was 11 (IQR 7–14). The median number of mature oocytes was 7.5 (IQR 5–12) oocytes. The univariate regression model evaluating the duration of time off testosterone before ART demonstrated no significant association with the outcome of mature oocytes (regression coefficient, 0.19; 95% confidence interval, –0.13 to 0.50). Conclusion: In a retrospective analysis of transgender patients recently on testosterone undergoing ART, no association was detected between the timing of testosterone cessation and the number of mature oocytes.

Increasingly, employers are seeking candidates with transferable skills in addition to technical and educational requirements. Thus, university students seek opportunities to develop transferrable skills, often through extra and co-curricular programs. With this in mind, our research explores student assessments of their own development of transferable skills after participation in a co-curricular, experiential volunteer program (McMaster Children and Youth University) in Canada. Using pre/post-survey methods, we find statistically significant increases in participants' self-assessments of leadership, problem solving, knowledge translation, and knowledge mobilization. Adaptability emerges as an unexpected skill several participants report developing as a result of working with young people. We conclude that co-curricular programs play an important role in transferable skill development. Further, we argue that social contexts of experiential learning opportunities play a significant role in shaping transferrable skill development.

Randomized controlled trials (RCTs) are the most robust study design for evaluating the safety and efficacy of a therapeutic intervention. However, their internal validity are at risk when evaluating surgical interventions. This review summarizes existing expertise-based trials in surgery and related methodological concepts to guide surgeons performing this work. We provide caseloads required to reach the learning curve for various surgical interventions and report criteria for expertise from published and unpublished expertise-based trials. In addition, we review design and implementation concepts of expertisebased trials, including recruitment of surgeons, crossover, ethics, generalizability, sample size and definitions for learning curve. Several RCTs have used an expertise-based design. We found that the majority of definitions used for expertise were vague, heterogeneous, and inconsistent across trials evaluating the same surgical intervention. Statistical methods exist to adjust for the learning curve; however, there is limited guidance. We developed the following criteria for surgical expertise for future trials: 1) decide on the proxy to be used for the learning curve, and 2) assess eligible surgeons by comparing their performance to the previously defined expertise criteria. L'essai randomisé et contrôlé (ERC) représente le modèle d'étude le plus solide pour évaluer l'innocuité et l'efficacité d'une intervention, mais sa validité interne est compromise lorsqu'on évalue des interventions chirurgicales. Cette revue résume les essais existants sur l'expertise en chirurgie et les concepts méthodologiques connexes pour guider les chirurgiens dans leur travail. Nous donnons les volumes de cas requis pour atteindre la courbe d'apprentissage propre à diverses interventions chirurgicales et nous citons les critères d'expertise mentionnés dans les rapports d'essais sur l'expertise publiés et non publiés. Nous passons également en revue les protocoles et les concepts de mises en oeuvre des essais sur l'expertise, y compris le recrutement des chirurgiens, la permutation des groupes, l'éthique, la généralisabilité, la taille des échantillons et les définitions des courbes d'apprentissage. Plusieurs ERC ont utilisé un modèle basé sur l'expertise. Nous avons découvert que la majorité des définitions du terme expertise utilisées étaient vagues, hétérogènes et nconstantes d'un essai à l'autre pour une même intervention chirurgicale. Il existe des méthodes statistiques pour ajuster la courbe d'apprentissage; par contre, on déplore un manque de directives. Nous avons établi les critères suivants pour juger de l'expertise chirurgicale en vue de futurs essais : 1) choisir la mesure indirecte à utiliser pour la courbe d'apprentissage, et 2) évaluer les chirurgiens admissibles en comparant leur rendement aux critères d'expertise définis précédemment., Randomized controlled trials (RCTs) are the most robust study design for assessing an intervention's efficacy and safety. However, when assessing skill-dependent interventions such as surgical interventions, their internal validity can [...]

Abstract Study Objective The objective of this study was to conduct a systematic review and meta‐analysis of the diagnostic accuracy of the clinical signs, symptoms, laboratory investigations, and imaging modalities commonly used in patients with clinically suspected renal colic. Methods We conducted this systematic review and meta‐analysis according to an a priori, registered protocol (PROSPERO CRD42017055153). A literature search was performed using MEDLINE and EMBASE from inception to July 2, 2020. We assessed the risk of bias using Quality Assessment of Diagnostic Accuracy Studies–2, calculated likelihood ratios (LRs), and applied a random‐effects model for meta‐analysis. Results Among 7641 references screened, 76 were included in the systematic review and 53 were included in the meta‐analyis. The overall pooled prevalence for ureteral stones was 63% (95% confidence interval [CI], 58%–67%). No individual demographic feature, symptom, or sign when present had an LR+ ≥2.0 for identifying ureterolithiasis. A (Sex, Timing and Origin of pain, race, presence or absence of Nausea, and Erythrocytes) STONE score ≥10 increased (sensitivity 0.49, specificity 0.91, LR 5.3 [95% CI, 4.1–6.7]) and a STONE score

Dry friction tests were performed using a pin-on-plate tribological tester. In this study, Al2O3 and Al2O3 with MoS2 admixture plate with PEEK/BG pin. Plate surfaces were created using the constant current method and the non-periodic alternating current method. The dimension of Al2O3 fibers walls were calculate based on SEM micrographs. SGP measurements of the oxide layers were made by a Taylor Hobson Talysurf 2D pin profilometer. It was found that the gradient structure favors the reduction of the friction coefficient and weight loss of PEEK/BG in the tested friction pairs, and the method of gradually reducing non-periodic alternating current allowed to obtain a more homogeneous microstructure of aluminum oxide. The use of high current densities at the beginning of the process leads to the production of non-gradient coatings characterized by higher SGP amplitude parameters. This property translates directly into higher wear of the sliding PEEK/BG material and higher values of the friction coefficients of the tribological pairs thus obtained. The research also identified a strong correlation between the friction coefficient µ and surface topography parameters before the tribological cooperation of PEEK/BG pairs - Al2O3 oxide coating.

Purpose: To evaluate the technical success and complication rates of vascular closure devices (VCDs) in the axillary artery. Materials and Methods: MEDLINE and Embase were searched independently by two reviewers to identify observational studies from inception through October 2021. The following outcomes were meta-analyzed: technical success, hematoma, dissection, pseudoaneurysm, infection, and local neurological complications. Complications were also graded as mild, moderate, and severe. A logistic regression evaluating the influence of sheath size for the outcome of technical success rate was performed using individual patient–level data. Results: Of 1496 unique records, 20 observational studies were included, totaling 915 unique arterial access sites. Pooled estimates were as follows: technical success 84.8% (95% confidence interval [CI]: 78%–89.7%, I2=60.4%), hematoma 7.9% (95% CI: 5.8%–10.6%, I2=0%), dissection 3.1% (95% CI: 1.3%–7.3%, I2=0%), pseudoaneurysm 2.7% (95% CI: 1.3%–5.7%, I2=0%), infection <1% (95% CI: 0%–5.7%, I2=20.5%), and local neurological complications 2.7% (95% CI: 1.7%–4.4%, I2=0%). There was a significant negative association between sheath size and technical success rate (odds ratio [OR]: 0.87 per 1 French (Fr) increase in sheath size, 95% CI: 0.80–0.94, p=0.0005). Larger sheath sizes were associated with a greater number of access-site complications (adjusted odds ratio [aOR]: 1.21 per 1 Fr increase sheath size, 95% CI: 1.04–1.40, p=0.013). Conclusions: Off-label use of VCDs in the axillary artery provides an 85% successful closure rate and variable complication rate, depending on the primary procedure and sheath size. Larger sheaths were associated with a lower technical success and greater rate of access-related complications. Clinical Impact: Safe arterial access is the foundation for arterial intervention. While the common femoral artery is a well established access site, alternative arterial access sites capable of larger sheath sizes are needed in the modern endovascular era. This article provides the largest synthesis to date on the use of vascular closure devices for percutaneous axillary artery access in endovascular intervention. It should serve clinicians with added confidence around this approach in terms of providing a reference for technical success and complications. Clinically, this data is relevant for patient consent purposes as well as for practice quality improvement in setting safety standards for this access site. [ABSTRACT FROM AUTHOR]

Objective: The day-to-day experience of families with an Autistic child may be shaped by both, child characteristics and available resources, which often are influenced by the socioeconomic context of the family. Using a socioecological approach, this study explored the quantitative associations between child autistic symptoms, family socioeconomic status, and family life.Methods: Data came from the Pediatric Autism Research Cohort—PARC Study (pilot). Parents of children with a recent diagnosis of autism completed a set of assessments, including the Autism Family Experience Questionnaire, Autism Impact Measure, and a Sociodemographic Questionnaire. A series of multiple, iterative linear regression models were constructed to ascertain quantitative associations between child autistic symptoms, socioeconomic context, and family life.Results: A total of 50 children (mean age: 76 months; SD: 9.5 months; and 84% male) with data on the variables of interest were included in the analysis. The frequency of child autistic symptoms was associated with family life outcomes (p = 0.02 and R2 = 24%). Once autistic symptom frequency, symptom impact, and sociodemographic variables were considered, parents of higher educational attainment reported worse family life outcomes compared to their lesser-educated counterparts. This cumulative regression model had considerable explanatory capability (p = 0.01, R2 = 40%).Conclusion: This study demonstrates the utility of using a socioecological approach to examine the dynamic interplay between child characteristics and family circumstances. Our findings suggest that family life for parents (of an autistic child) who have obtained higher education is reported (by the parents themselves) as less satisfactory compared to that of parents without higher education, once adjusted for the autistic symptom frequency of child, symptom impact, and income. These findings can inform the design and delivery of more family-centered care pathways during the years following a diagnosis of autism.

Abstract Background Collagen cross-linking (CXL) is an evolving procedure that enhances the biomechanical rigidity of the cornea and can slow or halt ectatic disease. CXL requires delivery of 5.4 J/cm2 of ultraviolet A (UVA) radiation to a cornea saturated with riboflavin in order to induce cross-link formation. The conventional CXL procedure achieves this fluence by exposing the cornea to a 3 mW/cm2 UVA lamp for 30 min; however, some surgeons have proposed accelerated protocols which achieve the same fluence in a shorter period of time by using a higher power light source. Whether accelerated protocols are as effective in arresting ectasia as the established conventional procedure remains unclear. Accordingly, this study will systematically review and synthesise the evidence on accelerated CXL and compare it to the conventional approach across an array of clinical outcomes. Methods We will search 16 electronic databases, including MEDLINE, Embase, and the Cochrane Library, from inception to February 1, 2019. We will include all randomised controlled trials comparing accelerated and conventional CXL for any corneal ectatic disease. Two reviewers will independently screen search results to identify eligible articles, complete data collection, and conduct quality assessment. The quality of individual trials will be assessed using the Cochrane Collaboration’s Risk of Bias Assessment Tool. Our primary outcome will be the change in maximal keratometry (K max) at 12 months following treatment. Additional outcomes will include: incidence of disease progression, incidence of serious adverse events, as well as change in K max at longest follow-up, mean stromal demarcation line depth, mean uncorrected distance visual acuity, mean corrected distance visual acuity, mean K max, mean endothelial cell density, mean central corneal thickness, mean spherical equivalent, mean intraocular pressure, and mean corneal power, at 12 months following treatment. We will calculate relative risks and 95% confidence intervals (CIs) for dichotomous outcomes and weighted mean differences and corresponding 95% CIs for continuous outcomes. Prespecified subgroup analyses will be performed to investigate heterogeneity. We will rate the overall quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Discussion This review will provide a comprehensive evaluation of the evidence on accelerated and conventional CXL approaches and serve to inform clinical practice, medical device design, and future research. Evaluating variations of the CXL protocol aimed at reducing treatment duration is of critical importance and a prerequisite to expanding treatment availability to more patients. Systematic review registration PROSPERO CRD42018104151

Background: Peripartum cardiomyopathy (PPCM) is a rare, life-threatening form of heart disease, frequently associated with gene alterations and, in some cases, presenting with advanced heart failure. Little is known about ventricular assist device (VAD) implantation in severe PPCM cases. We describe long-term follow-up of PPCM patients who were resistant to medical therapy and received mechanical circulatory support or heart transplant. Methods and results: A total of 13 patients were included with mean follow-up of eight years. Mean age of PPCM onset was 33.7 ± 7.7 years. All patients were initially treated with angiotensin-converting enzyme inhibitors and beta-blockers, and four received bromocriptine. Overall, five patients received VADs (three biventricular, two isolated left ventricular) at median 27 days (range: 3 to 150) following childbirth. Two patients developed drive line infection. Due to the short support time, none of those patients had a stroke or VAD thrombosis. In total, five patients underwent heart transplantation, of which four previously had implanted VADs. Median time to transplantation from PPCM onset was 140 days (range: 43 to 776), and time to transplantation from VAD implantation were 7, 40, 132, and 735 days, respectively. All patients survived until most recent follow up, with the exception of one patient who died following unrelated abdominal surgery two years after PPCM recovery. Conclusions: In patients with severe, life-threatening PPCM refractory to medical management, mechanical circulatory support with or without heart transplantation is a safe therapeutic option.

Background. The increasing consumption of dietary supplements (DS) can be observed all over the world. DSs are classified as food and not medicine, which consumers are not always aware of. Currently, a very wide range of dietary supplements for pregnant women is available. This is due to the fact that during this period, the demand for selected nutrients and vitamins increases. Objectives. The aim of the study was to assess the use of DS during pregnancy and to indicate the most frequently consumed ingredient during this period. Folic acid supplementation has also been reviewed. Material and methods. The subject of the study was a self-designed questionnaire consisting of 30 questions. The survey was conducted on 280 pregnant women living in Poland, aged 20–39. Results. Most of the surveyed women correctly defined DS. Over 90% of the surveyed women declared DS consumption during pregnancy. The decision to use DS was made in accordance with medical indications in the case of half of the subjects. Multi-ingredient products were used most often (81%). Conclusions. Most of the surveyed women took folic acid and DHA, followed by iron, iodine, magnesium and calcium. More than half of the women felt the positive effects of dietary supplements, while only a smaller percentage of the respondents declared negative effects. Consumption of DS by the surveyed women was similar to consumption in other countries. [ABSTRACT FROM AUTHOR]