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Background: General surgeons play an important role in the provision of trauma care in Canada and the current extent of their trauma experience during training is unknown. We sought to quantify the operative and nonoperative educational experiences among Canadian general surgery trainees. Methods: We conducted a multicentre retrospective study of major operative exposures experienced by general surgery residents, as identified using institutional trauma registries and subsequent chart-level review, for 2008-2018. We also conducted a site survey on trauma education and structure. Results: We collected data on operative exposure for general surgery residents from 7 programs and survey data from 10 programs. Operations predominantly occurred after hours (73% after 1700 or on weekends) and general surgery residents were absent from a substantial proportion (25%) of relevant trauma operations. The structure of trauma education was heterogeneous among programs, with considerable site-specific variability in the involvement of surgical specialties in trauma care. During their training, graduating general surgery residents each experienced around 4 index trauma laparotomies, 1 splenectomy, 1 thoracotomy, and 0 neck explorations for trauma. Conclusion: General surgery residents who train in Canada receive variable and limited exposure to operative and nonoperative trauma care. These data can be used as a baseline to inform the application of competency-based medical education in trauma care for general surgery training in Canada. Contexte : Les chirurgiennes et chirurgiens g n ralistes jouent un r le important dans la prestation de soins de traumatologie au Canada, et l' tendue actuelle de leur exp rience en traumatologie durant la formation est inconnue. Nous avons voulu quantifier les exp riences p dagogiques op ratoires et non op ratoires chez les stagiaires en chirurgie g n rale du Canada. M thodes : Nous avons men une tude r trospective multicentrique sur les expositions op ratoires majeures que vivent les r sidentes et r sidents en chirurgie g n rale, rep r es dans les registres de traumatologie des tablissements et dans le cadre d'un examen subs quent des dossiers, pour la p riode de 2008-2018. Nous avons aussi men une enqu te sur la formation en traumatologie et la structure de celle-ci. R sultats : Nous avons recueilli des donn es sur l'exposition op ratoire des r sidentes et r sidents en chirurgie g n rale de 7 programmes ainsi que des donn es d'enqu te de 10 programmes. Les interventions chirurgicales avaient principalement lieu en dehors des heures normales (73% apr s 17h ou la fin de semaine), et les r sidentes et r sidents taient absents d'une proportion consid rable (25%) des interventions de traumatologie pertinentes. La structure de la formation sur le sujet tait h t rog ne entre les programmes, avec une importante variation d'un tablissement l'autre dans la participation des sp cialit s chirurgicales dans les soins de traumatologie. Durant leur formation, les r sidentes et r sidents en chirurgie g n rale qui terminaient leurs tudes avaient chacun particip environ 4 laparotomies initiales de traumatologie, 1 spl nectomie, 1 thoracotomie et 0 exploration du cou pour un trauma. Conclusion : Les r sidentes et r sidents en chirurgie g n rale form s au Canada sont expos s de fa on variable et limit e aux soins de traumatologie op ratoires et non op ratoires. Ces donn es peuvent servir de valeur de r f rence pour orienter l'application d'une formation m dicale fond e sur les comp tences en traumatologie dans la formation en chirurgie g n rale au Canada., Traumatic injury is the leading cause of death and disability for Canadians aged 1-44 years. (1) Care for the trauma patient is provided by a multitude of providers, most notably [...]

Background: The federal Cannabis Act came into force on Oct. 17, 2018, in Canada, making Canada only the second country in the world to legalize the cultivation, acquisition, possession and consumption of cannabis and its by-products. This provided a unique opportunity to evaluate the impact of this legislation on drug-related trauma. Methods: We performed a prospective observational study on the use of cannabis and other illicit drugs in the trauma population at a lead Canadian trauma centre in London, Ontario, in the 3 months before (July 1 to Sept. 30, 2018) and 3 months after (Nov. 1, 2018, to Jan. 31, 2019) the legalization of cannabis in Canada. We defined cannabis use as a positive cannabinoid screen result at the time of assessment by the trauma team. We also screened for opioids, amphetamines and cocaine. Results: A total of 210 patients were assessed by our trauma service between July 1 and Sept. 30, 2018, and 141 patients were assessed between Nov. 1, 2018, and Jan. 31, 2019. Motor vehicle collisions were the most common cause of trauma both before (101 [48.1%]) and after (67 [47.5%]) legalization. The mean Injury Severity Score was 17.6 (standard deviation [SD] 13.0) and 19.7 (SD 14.8), respectively. Drug screens were done in 88 patients (41.9%) assessed before legalization and 99 patients (70.2%) assessed after legalization. There was no difference in the rate of positive cannabinoid screen results before and after legalization (22 [25%] v. 22 [22%]). There was a trend toward higher rates of positive cannabinoid screen results (2/10 [20%] v. 5/8 [62%]) and positive toxicology screen results (5/10 [50%] v. 6/8 [75%]) after legalization among patients with penetrating trauma, but our sample was too small to achieve statistical significance. Conclusion: We found no difference in the rates of positive cannabinoid screen results among patients assessed at our trauma centre in the 3 months before and the 3 months after legalization of cannabis; however, there was a trend toward an increase in the rates of positive results of toxicology screens and cannabinoid screens among those with penetrating trauma. These preliminary single-centre data showing no increased rates of cannabis use in patients with trauma after legalization are reassuring. Contexte: La Loi federate sur le cannabis est entree en vigueur ici le 17 octobre 2018, faisant du Canada le second pays a legaliser la culture, l'acquisition, la possession et la consommation du cannabis et de ses produits derives. Cette situation fournit une occasion unique d'evaluer l'impact de cette loi sur les traumatismes lies aux drogues. Methodes: Nous avons procede a une etude d'observation prospective sur la con-sommation du cannabis et d'autres drogues illicites chez une population de victimes de traumatismes dans un grand centre canadien de traumatologie de London, en Ontario, au cours des 3 mois precedant (1er juillet au 30 septembre 2018) et des 3 mois suivant (1er novembre 2018 au 31 janvier 2019) la legalisation du cannabis au Canada. La consommation de cannabis etait confirmee par l'obtention de resultats positifs aux tests de depistage des cannabino'ides demandes par l'equipe de traumatologie. Nous avons aussi effectue un depistage des opio'ides, des amphetamines et de la cocaine. Resultats: En tout, notre service de traumatologie a vu 210 patients entre le 1er juillet et le 30 septembre 2018, et 141 entre le 1er novembre 2018 et le 31 janvier 2019. Les accidents de la route ont ete la plus frequente cause de traumatisme avant (101 [48,1 %]) et apres (67 [47,5 %]) la legalisation. L'indice moyen de gravite des blessures a ete de 17,6 (ecart-type [E.-T.] 13,0) et 19,7 (E.-T. 14,8), respectivement. Un depistage de drogues a ete effectue chez 88 patients (41,9 %) vus avant la legalisation et chez 99 patients (70,2 %) vus apres la legalisation. On n'a observe aucune difference quant aux taux de resultats positifs aux tests de depistage des cannabino'ides enregistres avant et apres la legalisation (22 [25 %] c. 22 [22 %]). Les taux de resultats positifs aux tests de depistage des cannabino'ides (2/10 [20 %] c. 5/8 [62 %]) et aux tests toxicologiques (5/10 [50 %] c. 6/8 [75 %]) ont eu tendance a etre plus eleves apres la legalisation chez les patients victimes de traumatismes penetrants, mais notre echantillon etait trop petit pour atteindre une portee statistique. Conclusion: Nous n'avons observe aucune difference quant aux taux de resultats positifs au depistage des cannabino'des au cours des 3 mois precedant et suivant la legalisation du cannabis; par contre, les taux de resultats positifs aux tests de depistage des drogues et du cannabis ont eu tendance a etre plus eleves chez les victimes de trau-matismes penetrants. Ces donnees preliminaires provenant d'un seul centre qui ne montrent pas d'augmentation des taux de consommation de cannabis chez les poly-traumatises sont rassurantes., On Oct. 17, 2018, the federal Cannabis Act came into force in Canada, making this country only the second country in the world to legalize the cultivation, acquisition, possession and [...]

Whether to temporarily place retrievable inferior vena cava filters for prophylaxis against pulmonary embolism in high-risk trauma patients has been a difficult question to answer. Guidelines regarding the management of these patients are mixed in their recommendations. The question merits further attention., The question of whether there is a role for the temporary placement of retrievable inferior vena cava (IVC) filters for prophylaxis against pulmonary embolism (PE) in high-risk trauma patients has [...]

Objective: Concerns that medical assistance in dying (MAiD) may harm vulnerable groups unable to access medical treatments and social supports have arisen since the legalization of MAiD on June 17, 2016; however, there is little research on the topic. The purpose of this study is to investigate the socioeconomic status (SES) of patients who request MAiD at the London Health Sciences Centre (LHSC). Methods: A retrospective analysis of patients from the LHSC MAiD database between June 6, 2016 and December 20, 2019 was conducted. Patients were linked to income data from the 2016 Canadian Census, and their corresponding income quintile was a proxy for SES. Geographic information system (GIS) mapping software was used to visualize the distribution of income and MAiD requests. Results: 39.4% of the LHSC catchment area was classified as low SES. Two hundred thirty-seven (58.1%) MAiD requests came from low SES patients and 171 (41.9%) requests came from high SES patients. Two hundred fifty-nine (63.5%) patients who requested a MAiD assessment did not receive MAiD following their request. Of the 237 lower SES patients, 150 (63.3% [95% CI 57.2-69.3]) did not receive MAiD. Of the 171 higher SES patients, 109 (63.7% [95% CI 56.5-70.9]) did not receive MAiD. Conclusion: A disproportionate number of requests for a MAiD assessment at LHSC came from lower SES patients; however, similar proportions of patients who requested MAiD from each SES group received aid in dying. Future research should explore why a disproportionately high number of low SES patients request MAiD at LHSC. [ABSTRACT FROM AUTHOR]

Purpose: To describe factors (demographics and clinical characteristics) that predict patients who are at an increased risk of adverse events or unplanned return visits to a health-care facility following discharge direct to home (DDH) from intensive care units (ICUs). Methods: Prospective cohort study of all adult patients who survived their stay in our medical--surgical--trauma ICU between February 2016 and 2017 and were discharged directly home. Patients were followed for 8 weeks postdischarge. Univariable and multivariable logistic regression analyses were performed to identify factors associated with adverse events or unplanned return visits to a health-care facility following DDH from ICU. Results: A total of 129 DDH patients were enrolled and completed the 8-week follow-up. We identified 39 unplanned return visits (URVs). There was 0% mortality at 8 weeks postdischarge. Eight potential predictors of hospital URVs (P < .2) were identified in the univariable analysis: prior substance abuse (odds ratio [OR] of URV of 2.50 [95% confidence interval: 1.08-5.80], hepatitis (OR: 6.92 [1.68-28.48]), sepsis (OR: 11.03 [1.19-102.29]), admission nine equivalents of nursing manpower score (NEMS) <24 (OR: 2.28 [1.03-5.04], no fixed address (OR: 22.9 [1.2-437.3]), ICU length of stay (LOS) <2 days (OR: 2.95 [1.28-6.78]), home discharge within London, Ontario (OR: 2.44 [1.00-5.92]), and left against medical advice (AMA; OR: 6.06 [2.04-17.98]). Conclusions: Our study identified 8 covariates that were potential predictors of URV: prior substance abuse, hepatitis, sepsis, admission NEMS <24, no fixed address, ICU LOS <2 days, home discharge within London, Ontario, and left AMA. The practice of direct discharges home from the ICU would benefit from adequately powered multicenter study in order to construct a clinical prediction model (that would require further testing and validation). [ABSTRACT FROM AUTHOR]

Purpose: The use of etomidate as an induction agent for critically ill patients is controversial. While its favorable hemodynamic profile is enviable, etomidate has been shown to cause transient adrenal suppression. The clinical consequences of transient adrenal suppression are poorly understood. Anecdotally, some clinicians advocate strongly for etomidate, while others feel it can cause significant harm. To better understand the current clinical environment with respect to single-dose etomidate use in critically ill patients, Canadian anesthesiologists and Canadian emergency medicine (EM) physicians were questioned regarding their opinions, knowledge, and preferences about etomidate use as an induction agent. Methods: Invitations to participate with the electronic survey were sent to 100 Canadian EM physicians and 260 Canadian anesthesiologists. The survey had 4 general parts: demographics, familiarity with the current literature, choice of induction agent given various clinical scenarios, and opinions on the controversy. The Pearson γ² test was used to detect whether significant differences exist between physician groups. Results: Ninety three anesthesiologists and 42 EM physicians responded for response rates of 36% and 42%. There were no self-reported differences in knowledge about etomidate properties between EM physicians and anesthesiologists. There were significant differences in etomidate use between EM physicians and anesthesiologists in general rapid sequence intubation, noncritically ill patients, and those with undifferentiated hypotension. Both EM physicians and anesthesiologists describe the current etomidate controversy as significant and not adequately resolved. Conclusion: There is no significant difference in selfreported etomidate knowledge between anesthesiologists and EM physicians; however, significant practice pattern differences exist with EM physicians using etomidate more often. Broad agreement supports future research to investigate etomidate's impact in critically ill patients. [ABSTRACT FROM AUTHOR]

Objective: Critical care echocardiography has become an integral tool in the assessment and management of critically ill patients. Critical care transesophageal echocardiography (TEE) offers diagnostic reliability, superior image quality, and an expanded diagnostic scope to transthoracic echocardiography. Despite its favorable attributes, TEE use in North American intensive care units (ICUs) remains relatively undescribed. In this article, we seek to characterize the feasibility, indications, and clinical impact of a critical care TEE program. Design: Retrospective, observational study. Setting: Tertiary care, academic critical care program consisting of 2 hospitals in Ontario, Canada. Participants: Consecutive critical care TEE examinations on ICU patients performed between December 2012 and December 2016 Interventions: None. Measurements and Main Results: Consecutive critical care TEE studies on ICU patients from December 1, 2012, to December 31, 2016, were reviewed. The TEEs performed on cardiac surgery patients and those without reports were excluded. Examination details, including indications, complications, examination complexity (number of views, Doppler techniques), and clinical recommendations were aggregated and analyzed. Two hundred seventy-four TEE studies were performed by 38 operators. Common indications for TEE studies were hemodynamic instability (45.2%), assessment for infective endocarditis (22.2%), and cardiac arrest (20.1%). A change in patient management was proposed following 79.5% of TEE studies. Thirty-eight percent of TEE studies were performed during evening hours or on weekends. There were no mechanical complications. Conclusions: Our observational data support intensivist-performed TEE as being safe and therapeutically influential across a broad range of indications. Our program's demonstrated feasibility and impact may act as a model for TEE adoption in other North American ICUs. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)