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BackgroundOne aim of publicly-funded health care systems is to provide equitable access to care irrespective of ability to pay. At the same time, differences in socioeconomic status (SES) are associated with health outcomes and access to care, including waiting times for surgery. In public systems where both high- and low-SES patients use the same resources, low-SES patients may be adversely impacted in surgical waiting times. The purpose of this study was to determine whether a publicly-funded health system can provide equitable access to surgical care across socioeconomic status.MethodsPatient-level records were obtained from a comprehensive provincially-administered surgical wait time database, encompassing years 2006-2015 and 98% of Ontario hospitals. Patient SES was determined by linking postal code with the Material and Social Deprivation Index. Surgical waiting times (time in days between decision to treat and surgery) accounted for patient-initiated delays in treatment, and regression analysis considered age, SES, rurality, sex, priority level for surgical urgency (assigned by surgeons), surgical subspecialty, number of visits, and procedure year.ResultsFor the 4,253,305 surgical episodes, the mean wait time was 62.3 (SD 75.4) days. Repeated measures least squares regression analysis showed the least deprived SES quintile waited 3 days longer than the most deprived quintile. Wait times dropped in the initial study period but then increased. The proportion of procedures exceeding wait time access targets remained low at 11-13%.ConclusionsThe least deprived SES quintile waited the longest, although the absolute difference was small. This study demonstrates that publicly-funded healthcare systems can provide equitable access to surgical care across SES.

Background: Studies have estimated that a large backlog of procedures was generated by emergency measures implemented in Ontario, Canada, at the onset of the COVID-19 pandemic, when nonessential and scheduled procedures were postponed. Understanding the impact of the COVID-19 pandemic on the time needed to perform a procedure may help to determine the resources needed to tackle the substantial backlog caused by the deferral of cases. The purpose of this study was to examine the duration of operating room (OR) procedures before and after the onset of the COVID-19 pandemic to inform planning around changes in required resources. Methods: A population-based, retrospective cohort study was conducted using Ontario Health Insurance Plan claims data and other administrative health care data from Apr. 1, 2019, to Sept. 30, 2020. Statistical analysis was conducted using multivariate regression, with procedure duration as the outcome variable. Results: Results showed that the average duration of nonelective procedures increased by 34 minutes during the COVID-19 period and by 19 minutes after the resumption of scheduled procedures. Controlling for physician, patient and hospital characteristics, and the procedure code submitted, procedure duration increased by 12 minutes in the nonelective COVID-19 period and by 5 minutes when scheduled procedures resumed, compared with the pre-COVID-19 period. Conclusion: Procedures may take longer in the COVID-19 period. This will affect wait times, which had already increased because of the deferral of procedures at the beginning of the pandemic, and will have an impact on Ontario's ability to provide patients with timely care. Contexte : Selon des etudes, on estime que la mise en place des mesures d'urgence en Ontario (Canada) au debut de la pandemie de COVID-19, qui ont entraine le report de toutes les interventions planifiees et non essentielles, a mene a l'accumulation d'un retard important des interventions chirurgicales. Comprendre l'incidence de la pandemie de COVID-19 sur le temps necessaire pour realiser une intervention pourrait aider a determiner les ressources requises pour s'attaquer a cet arriere considerable. Le but de cette etude etait d'observer la duree des interventions en salle d'operation avant et apres le debut de la pandemie de COVID-19 pour mieux planifer les changements aux ressources necessaires. Methodes : Une etude de cohorte retrospective populationnelle a ete menee a l'aide des donnees sur les reclamations medicales soumises au Regime d'assurance-sante de l'Ontario et d'autres donnees administratives sur les soins de sante du 1 (er) avril 2019 au 30 septembre 2020. L'analyse statistique a ete realisee au moyen d'une regression multivariable, ou la duree de l'intervention constituait la variable dependante. Resultats : Les resultats ont montre que la duree moyenne des interventions non urgentes a augmente de 34 minutes durant la periode de restrictions associees a la COVID-19, et de 19 minutes apres la reprise des interventions planifees. En tenant compte de variables comme les caracteristiques du medecin, du patient et de l'hopital ainsi que des codes d'acte soumis, le temps moyen des interventions a augmente de 12 minutes pendant la periode de restrictions associees a la COVID-19 pour les interventions non urgentes et de 5 minutes apres la reprise des interventions planifees comparativement a la periode precedant la COVID-19. Conclusion : Les interventions peuvent prendre plus de temps en contexte de COVID-19. Cela influencera les temps d'attente, qui ont deja augmente en raison du report des interventions au debut de la pandemie, et aura des repercussions sur la capacite de l'Ontario a fournir aux patients des soins dans des delais raisonnables., On Mar. 11, 2020, the World Health Organization (WHO) declared COVID-19 a global pandemic. (1) Since then, 90% of countries have reported an interruption in essential health services caused by [...]

Background: Removal of instrumentation is often recommended as part of treatment for spinal infections, but studies have reported eradication of infection even with instrumentation retention by using serial debridements and [...]

Background: Stereotype threat, defined as the predicament felt by people in either positive or negative learning experiences where they could conform to negative stereotypes associated with their own group membership, can interfere with learning. The purpose of this study was to determine if a simple orientation session could reduce stereotype threat for orthopedic residents. Methods: The intervention group received an orientation on 2 occasions focusing on their possible responses to perceived poor performance in teaching rounds and the operating room (OR). Participants completed a survey with 7 questions typical for stereotype threat evaluating responses to their experiences. The questions had 7 response options with a maximum total score of 49, where higher scores indicated greater degree of experiences typical of stereotype threat. Results: Of the 84 eligible residents, 49 participated: 22 in the nonintervention and 27 in the intervention group. The overall scores were 29 and 29.4, and 26.2 and 25.8 in the nonintervention and intervention groups for their survey responses to perceived poor performance in teaching rounds (p = 0.85) and the OR (p = 0.84), respectively. Overall, responses typical of stereotype threat were greater for perceived poor performance at teaching rounds than in the OR (p = 0.001). Conclusion: Residents experience low self-esteem following perceived poor performance, particularly at rounds. A simple orientation designed to reduce stereotype threat was unsuccessful in reducing this threat overall. Future research will need to consider longer-term intervention as possible strategies to reduce perceived poor performance at teaching rounds and in the OR. Contexte : La menace du stereotype, definie comme un malaise ressenti chez des individus en situation d'apprentissage positive ou negative ou ils pourraient se conformer au stereotype negatif associe a leur groupe d'appartenance, peut nuire a l'apprentissage. Le but de cette etude etait de determiner s'il est possible de reduire la menace du steoreotype chez des residents en orthopedie au moyen d'une simple seance d'orientation. Methodes : Le groupe soumis a l'intervention a assiste a 2 seances d'orientation visant leurs reactions possibles a un pietre rendement percu lors de cours cliniques ou au bloc operatoire. Les participants ont repondu a un sondage de 7 questions typiques concernant la menace du stereotype pour evaluer leurs reactions a de telles experiences. Les questions comportaient 7 choix de reponse, pour un score total maximum de 49; les scores les plus eleves indiquaient un degre plus marque d'experiences concordant avec la menace du stereotype. Resultats : Parmi les 54 residents admissibles, 49 ont participe : 22 dans le groupe non soumis a l'intervention et 27 dans le groupe soumis a l'intervention. Les scores globaux ont ete de 29 et de 29,4, et de 26,2 et 25,8 dans les groupes non soumis a l'intervention et soumis a l'intervention (p = 0,85), respectivement, pour leurs reponses au sondage liees a un pietre rendement percu lors des cours cliniques ou au bloc operatoire. Dans l'ensemble, les reponses typiques de la menace du stereotype ont ete plus marquees en ce qui concerne un pietre rendement percu lors des cours cliniques qu'au bloc operatoire (p = 0,001). Conclusion : Les residents ont une faible estime d'eux-memes apres un pietre rendement percu, particulierement lors des cours cliniques. Une simple seance d'orientation concue pour reduire la menace du stereotype n'a pas reussi a l'attenuer dans l'ensemble. Il faudra approfondir la recherche pour envisager une intervention a plus long terme comme strategie envisageable pour reduire la perception d'un pietre rendement lors des cours cliniques et au bloc operatoire., Surgical residents come from diverse backgrounds, posing many challenges, including the need for creating an effective learning environment. While new models of residency training are emerging, the individual needs of [...]