Cardiac Link: a retrospective cohort study evaluating a clinical pathway for expedited cardiology referral.

BACKGROUND: Outpatients presenting with chest pain often face long wait times for cardiology consultation and subsequent investigation for obstructive coronary artery disease (CAD), during which adverse cardiovascular events may occur. Our objective was to describe the design of Cardiac Link, a coronary computed tomography angiogram (CCTA)-guided rapid-access program, and evaluate its effect on cardiology consultation wait times in patients who present to primary care physicians with stable chest pain. METHODS: We conducted a retrospective cohort study at Women's College Hospital, Toronto, Ontario, Canada, between 2017 and 2020 involving eligible patients from the Family Practice Health Centre who underwent CCTA after presenting with stable chest pain or equivalent symptoms. Referring primary care physicians decided on a patient-by-patient basis to opt into the Cardiac Link program when requesting CCTA. Our primary outcome was measure of time from CCTA to cardiology consultation, and our secondary outcomes were measures of time to diagnosis from primary care consultation and CCTA booking time. RESULTS: Our analysis included 148 patients (Cardiac Link n = 98, non-Cardiac Link n = 50). Mean age of the patients was 58.4 (SD 11.2) years and 72% (107/148) were women. We found that the Cardiac Link group had a shorter time from CCTA to cardiology consultation (median 7 [interquartile range {IQR} 6-20] d v. median 100 [IQR 40-138] d; p = 0.01), shorter time to diagnosis (median 33 [IQR 22-55] d v. median 86 [IQR 40-112] d; p < 0.001) and shorter CCTA booking time (median 18 [IQR 11-31] d v. median 65 [IQR 24-92] d; p < 0.001) compared with the non-Cardiac Link group. INTERPRETATION: We determined that the Cardiac Link program reduced cardiology consultation wait times for symptomatic patients who were suspected of having CAD. Our study shows the viability of CCTA-guided rapid-access programs to expedite specialist consultation and reduce unnecessary referral for patients presenting to primary care physicians with stable chest pain.

No. 279-Female Sexual Health Consensus Clinical Guidelines.

OBJECTIVE: To establish national guidelines for the assessment of women's sexual health concerns and the provision of sexual health care for women. EVIDENCE: Published literature was retrieved through searches of PubMed, CINAHL, and the Cochrane Library from May to October 2010, using appropriate controlled vocabulary (e.g., sexuality, "sexual dysfunction," "physiological," dyspareunia) and key words (e.g., sexual dysfunction, sex therapy, anorgasmia). Results were restricted, where possible, to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no language restrictions. Searches were updated on a regular basis and incorporated in the guideline to December 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Each article was screened for relevance and the full text acquired if determined to be relevant. The evidence obtained was reviewed and evaluated by the members of the Expert Workgroup established by The Society of Obstetricians and Gynaecologists of Canada. VALUES: The quality of evidence was evaluated and recommendations made using the use of criteria described by the Canadian Task Force on Preventive Health Care (Table).

Prevalence and Predictors of Sexual Problems Among Midlife Canadian Adults: Results from a National Survey.

BACKGROUND: Sexual problems are common among midlife men and women, and studies have identified a range of demographic, health, and relational correlates. Research on prevalence of these sexual problems within Canada is sparse and is warranted given the unique context related to provision of health care services in contrast to other countries. AIM: We investigated sexual problems (women's low desire, orgasm difficulties, and vaginal pain, as well as men's low desire, erection difficulties, and ejaculation difficulties) and their correlates among a large sample of Canadian men and women aged 40-59 years. METHODS: A national sample of Canadians was recruited (N = 2,400). Prevalence statistics for the sexual problems, and odds ratios for correlates were computed using logistic regression to identify demographic, health, and behavioral correlates of men' and women's sexual problems. OUTCOMES: Self-reported experiences in the last 6-months of low desire, vaginal dryness, vaginal pain, and orgasm difficulties for women, and low desire, erectile difficulties, and ejaculation problems for men. RESULTS: Sexual problems were relatively common; low desire was the most common sexual problem, particularly for women, with 40% reporting low sexual desire in the last 6 months. Women who were post-menopausal were much more likely to report low desire, vaginal pain, and vaginal dryness. Low desire and erectile difficulties for men, and low desire and orgasm difficulties for women were significant predictors of overall happiness with sexual life. CLINICAL TRANSLATION: Given the prevalence and impact of sexual problems indicated in our study, physicians are encouraged to routinely assess for and treat these concerns. CONCLUSIONS: Strengths include a national sample of an understudied demographic category, midlife adults, and items consistent with other national studies of sexual problems. Causal or directional associations cannot be determined with these cross-sectional data. Results are largely consistent with previous national samples in the United States and the United Kingdom. Sexual problems are common among Canadian men and women, with many being associated with self-reported sexual happiness. Quinn-Nilas C, Milhausen RR, McKay A, et al. Prevalence and Predictors of Sexual Problems Among Midlife Canadian Adults: Results from a National Survey. J Sex Med 2018;15:873-879.

No. 279-Female Sexual Health Consensus Clinical Guidelines.

OBJECTIVE: To establish national guidelines for the assessment of women's sexual health concerns and the provision of sexual health care for women. EVIDENCE: Published literature was retrieved through searches of PubMed, CINAHL, and the Cochrane Library from May to October 2010, using appropriate controlled vocabulary (e .g., sexuality, "sexual dysfunction," "physiological," dyspareunia) and key words (e .g ., sexual dysfunction, sex therapy, anorgasmia). Results were restricted, where possible, to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no language restrictions. Searches were updated on a regular basis and incorporated in the guideline to December 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Each article was screened for relevance and the full text acquired if determined to be relevant. The evidence obtained was reviewed and evaluated by the members of the Expert Workgroup established by The Society of Obstetricians and Gynaecologists of Canada. VALUES: The quality of evidence was evaluated and recommendations made using the use of criteria described by the Canadian Task Force on Preventive Health Care (Table).