A novel computerized approach to scoping reviews using Synthesis software: the first 15 years of The American College of Surgeons National Surgical Quality Improvement Program.

Scoping reviews of innovations in health care characterized by large numbers and types of publications present a unique challenge. A novel software application, Synthesis, can efficiently scan the literature to map the evidence and inform practice. We applied Synthesis to the National Surgical Quality Improvement Program (NSQIP), a high-quality database designed to measure risk-adjusted 30-day surgical outcomes for national and international benchmarking. The scoping review describes the breadth of studies in the NSQIP literature. We performed a comprehensive electronic literature search using PubMed, MEDLINE, Web of Knowledge and Scopus to capture all NSQIP articles published between Jan. 1, 2000, and Dec. 31, 2020. Two reviewers independently reviewed articles to determine their relevance using predefined inclusion criteria. We imported references into Synthesis to semiautomate data management. Extracted data included surgical specialty, study type and year of publication. Of the 4661 NSQIP articles included, 3631 (77.9%) were published within the last 5 years. Among NSQIP-related articles, the most common study types were based on outcomes (46.7%) and association (41.7%), and the most common surgical specialties were general surgery and orthopedic surgery, representing 35.7% and 24.0% of the articles, respectively. Synthesis enabled a rapid review of thousands of NSQIP publications. The scoping review provided an overview of the articles in the NSQIP literature and suggested that the NSQIP is increasingly being described in publications of quality and safety in surgery.

Breast Reconstruction Decision Aids Decrease Decisional Conflict and Improve Decisional Satisfaction: A Randomized Controlled Trial.

BACKGROUND: Decision aids are useful adjuncts to clinical consultations for women considering breast reconstruction. This study compared the impact of two online decision aids, the Breast RECONstruction Decision Aid (BRECONDA) and the Alberta Health Services (AHS) decision aid, on decisional conflict, decisional satisfaction, and decisional regret. METHODS: This randomized controlled trial included 60 women considering whether or not to undergo breast reconstruction. Two online decision aids, the AHS and the BRECONDA, were compared using randomized two-arm equal allocation. Participants responded to questionnaires at baseline, after the first and second consultations, and at 6 weeks and 6 months after deciding to, or not to, undergo reconstruction. Change in decisional conflict scores was compared between the BRECONDA and the AHS decision aid. Secondary outcomes included decisional regret and decisional satisfaction. RESULTS: Both groups were similar in demographic, clinical, and behavioral characteristics. Women spent more time consulting the BRECONDA in comparison to women using the AHS decision aid (56.7 ± 53.8 minutes versus 28.4 ± 27.2 minutes; P < 0.05). Decisional conflict decreased (P < 0.05), and decisional satisfaction improved over time in both groups (P < 0.05). However, there were no differences based on the type of decision aid used (P > 0.05). Both decision aids had a similar reduction in decisional regret (P > 0.05). CONCLUSIONS: Decision aids decrease decisional conflict and improve decisional satisfaction among women considering breast reconstruction. Physicians should therefore offer patients access to decision aids as an adjunct to breast reconstruction consultations to help patients make an informed decision. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

A Multidisciplinary Hand Clinic Using Physiatrists for the Evaluation of Non-Operative Pathologies.

PURPOSE: The purpose of this study was to describe the impact of using a multidisciplinary hand clinic on (1) hand clinic waitlists for urgent operative pathologies and (2) the volume of urgent operative referrals seen by plastic surgery. METHODS: A retrospective data analysis of all new referrals to the Peter Lougheed Centre hand clinic in Calgary, Alberta, was performed. Data were collected from 6 months before and after the introduction of the multidisciplinary model (ie, between January 2017 and January 2018). Demographics for all new referrals were collected from the clinic database, including wait times, triage type, and volume of referrals triaged to each discipline. RESULTS: Prior to using a multidisciplinary model, 81% (n = 591) of new patient referrals were triaged directly to plastic surgery, 4% (n = 28) to physiotherapy, and 6% (n = 43) to minor surgery (N = 728). However, following the addition of physiatry to the clinic, 62% (n = 451) of new patient referrals were triaged directly to plastic surgery, 24% (n = 173) to physiatry, 2% (n = 17) to physiotherapy, and 4% (n = 31) to minor surgery (N = 730). Overall, the number of urgent operative referrals triaged to plastic surgery proportionally increased by 7%, from 67% to 74%. Mean wait times for urgent referrals to plastic surgery decreased by 1.7 ± 1.0 months (P = .09). CONCLUSION: Applying a multidisciplinary model to a hand clinic can allow non-operative cases to be triaged directly to physiotherapy and physiatry, allowing plastic surgeons to manage a higher volume of urgent and operative referrals. Implementing a multidisciplinary hand clinic can, therefore, decrease waitlist volumes and shorten the time to assessment by a plastic surgeon. TYPE OF STUDY: Level II Prognostic Study.

OBJECTIF: La présente étude vise à décrire les répercussions d'une clinique multidisciplinaire de la main sur 1) la liste d'attente de pathologies devant être opérées d'urgence dans les cliniques de la main; 2) le volume de patients dirigés d'urgence vers la plasturgie. MÉTHODOLOGIE: Des chercheurs ont procédé à l'analyse rétrospective des données de tous les patients dirigés vers la clinique de la main du Peter Lougheed Centre de Calgary, en Alberta. Ils ont recueilli les données entre six mois avant et six mois après l'adoption du modèle multidisciplinaire (entre janvier 2017 et 2018). Ils ont extrait tous les nouveaux patients dirigés vers le centre figurant dans la base de données de la clinique, y compris les temps d'attente, le type de triage et le volume de triage vers chaque discipline. RÉSULTATS: Avant d'utiliser un modèle multidisciplinaire, 81 % (n=591) des nouveaux patients étaient triés directement vers la plasturgie, 4 % (n=28) vers la physiothérapie et 6 % (n=43), vers des interventions chirurgicales mineures (n=728). Cependant, après l'ajout de la physiatrie à la clinique, 62 % (n=451) des nouveaux patients étaient triés directement vers la plasturgie, 24 % (n=173), vers la physiatrie, 2 % (n=17), vers la physiothérapie et 4 % (n=31), vers des interventions chirurgicales mineures (n=730). Dans l'ensemble, la proportion de tris vers une opération d'urgence en plasturgie a augmenté de 7 %, passant de 67 % à 74 %. Les temps d'attente moyens des patients dirigés d'urgence vers la plasturgie ont diminué de 1,7±1,0 mois (p=0,09). CONCLUSION: Le recours à un modèle multidisciplinaire dans une clinique de la main permet de trier directement les cas n'ayant pas à être opérés vers la physiothérapie et la physiatrie. Les plasticiens peuvent ainsi prendre en charge un plus fort volume de patients qui leur ont été dirigés pour une urgence ou une opération. La création d'une clinique multidisciplinaire de la main peut donc réduire le volume de temps d'attente et l'attente avant l'évaluation par un plasticien. TYPE D'ÉTUDE: Étude pronostique de niveau II.

Thrombolysis of Postoperative Acute Pulmonary Embolism with a Thrombus in Transit.

Right heart thrombus in transit clot (RHTT) associated with a pulmonary thromboembolism (PTE) is a rare but potentially fatal diagnosis. Early diagnosis and immediate intervention are crucial. This report describes the case of a healthy, physically active 32-year-old female who presented 19 days postoperatively, following an anterior cruciate ligament reconstruction and partial lateral meniscectomy with a saddle PE, RHTT, and right ventricular (RV) strain. The patient received half of the standard dose of intravenous tissue plasminogen activator (TPA) in combination with anticoagulation and survived. Case reports of RHTT will inform future studies designed to evaluate whether and when thrombolysis should be administered.

Neighbourhood urban form and individual-level correlates of leisure-based screen time in Canadian adults.

OBJECTIVES: Despite evidence for an association between the built environment and physical activity, less evidence exists regarding relations between the built environment and sedentary behaviour. This study investigated the extent to which objectively assessed and self-reported neighbourhood walkability, in addition to individual-level characteristics, were associated with leisure-based screen time in adults. We hypothesised that leisure-based screen time would be lower among adults residing in objectively assessed and self-reported 'high walkable' versus 'low walkable' neighbourhoods. SETTING: The study was undertaken in Calgary, Alberta, Canada in 2007/2008. PARTICIPANTS: A random cross-section of adults who provided complete telephone interview and postal survey data (n=1906) was included. Captured information included leisure-based screen time, moderate-intensity and vigorous-intensity physical activity, perceived neighbourhood walkability, sociodemographic characteristics, self-reported health status, and self-reported height and weight. Based on objectively assessed built characteristics, participant's neighbourhoods were identified as being low, medium or high walkable. PRIMARY AND SECONDARY OUTCOME MEASURES: Using multiple linear regression, hours of leisure-based screen time per day was regressed on self-reported and objectively assessed walkability adjusting for sociodemographic and health-related covariates. RESULTS: Compared to others, residing in an objectively assessed high walkable neighbourhood, women, having a college education, at least one child at home, a household income ≥$120 000/year, and a registered motor vehicle at home, reporting very good-to-excellent health and healthy weight, and achieving 60 min/week of vigorous-intensity physical activity were associated (p<0.05) with less leisure-based screen time. Marital status, dog ownership, season, self-reported walkability and achieving 210 min of moderate-intensity physical activity were not significantly associated with leisure-based screen time. CONCLUSIONS: Improving neighbourhood walkability could decrease leisure-based television and computer screen time. Programmes aimed at reducing sedentary behaviour may want to consider an individual's sociodemographic characteristics, physical activity level, health status and weight status, in addition to the walkability of their neighbourhood as these factors were found to be important independent correlates of leisure-based screen time.