Neurosurgeons' Perspectives on Vascular Entrustable Professional Activities.

This article discusses subspecialty Canadian neurosurgeons' perceptions of entrustable professional activities (EPAs) assessments and variabilities prior to the implementation of the Competence by Design (CBD) system in Canada. Vascular neurosurgeons were asked to reflect on how they would evaluate and give feedback to neurosurgery residents concerning the EPA "Performing surgery for patients with an intracranial aneurysm." Interviews were transcribed and analyzed using a deductive approach. Themes were derived from these interviews and reflected on the subjectivity and biases present in the EPA assessment forms. Indeed, faculty may require more training in the transitioning to a CBD evaluation system.

What is the value of preoperative prophylactic heparin in reducing venous thromboembolism in major non-cardiac thoracic surgery?

BACKGROUND: Studies have investigated the utility of preoperative heparin to mitigate venous thromboembolism risk after surgery. However, whether heparin reduces the risk of VTE following major thoracic surgery is undetermined. A national heparin shortage beginning in September 2019 provided the opportunity for a natural experiment to explore this question. METHODS: A retrospective analysis was conducted including all major thoracic surgery cases at a single center from March 2019 to April 2020. The primary outcome was VTE. Two sample t-tests, Chi-Square analyses, and multivariable regressions were performed. RESULTS: The study consisted of 890 patients, 391 before the heparin shortage and 499 afterwards. 398 total patients received heparin, 340 before the heparin shortage and 58 afterwards. On univariate analyses, there was no association between VTE and preoperative heparin (p > 0.90). This remained consistent on multivariable analyses (p > 0.1). CONCLUSION: In this single center analysis, there was no association between preoperative heparin and the occurrence of postoperative VTE. Analyses in larger cohorts will provide additional evidence to guide policies on the use of preoperative prophylactic heparin.

The Governance of Helmet Safety to Prevent Traumatic Brain Injury in the Caribbean.

BACKGROUND: The Caribbean is a unique region of islands and cays home to nearly 43 million people. A significant challenge facing this population is the burden of traumatic brain injury, which disproportionately affects younger individuals and carries a significant economic burden. A preventive measure to reduce this burden is consistent wearing of helmets. This study aims to assess TBI prevention through helmet safety in Caribbean nations in order to demonstrate the regional impact of public health solutions. METHODS: We assess the member states of the Caribbean Community (CARICOM) and sought to evaluate CARICOM nations' TBI prevention through helmet safety with relation to public health, policy, laws, infrastructure, and regulations. We produced the Rolle Scoring System (RSS) to ascertain the influence of governance around helmet safety for TBI prevention. The RSS aims to provide a quantifiable method of how well a CARICOM nation is performing in efforts to reduce TBI. The RSS is broken down into 2 categories, with scores ranging from 1 (worst) to 5 (best). The range of possible scores a CARICOM nation could receive was 8 to 40. RESULTS: Fourteen CARICOM nations were ultimately incorporated into our analysis. From the initial cohort, 3 were removed. These nations were Anguilla, Saint Kitts & Nevis, and Montserrat. We analyzed values derived from the RSS, finding a mean Rolle score of 22. We further subdivided the nations into low Rolle score (8-24) and high Rolle score (>24). Trinidad and Tobago had the highest Rolle score at 29. Haiti was found to have the lowest Rolle score at 8. CONCLUSION: Several Caribbean nations have demonstrated leadership pertaining to TBI prevention through helmet safety. The regional momentum of helmet safety in the Caribbean can serve as a model for other geographical regional blocs that share interests and culture to consider comprehensive approaches to public health challenges.