Analyzing models of patient-centered care in Canada through a scoping review and environmental scan.

Aim: The objective of this study was to identify and synthesize models of patient-centered care in Canada and compare them with the normative models described in the literature. Subject and methods: Patient-centered care has gained momentum in the twenty-first century as a component of quality care. During the Covid-19 pandemic, the crisis often shifts the focus to the disease rather than the patient. The multiplicity of Canadian systems, including the federal, provincial, and territorial contexts, made a good case to search for a variety of models. This study was conducted using a scoping review method supported by an environmental scan to identify patient-centered care models in Canada. Results: The study identified 19 patient-centered interventions across Canada. The interventions included bedside interventions, patient-engagement projects at the organizational level, and citizen advisory panels at the system level. The organizational model was the most common. The goals of interventions ranged from enhancing the patient's experience of care to identifying ways to cut costs. In most organizational-level projects, there was a marked tendency to engage patients as members of quality improvement committees. Respecting patient dignity and autonomy in one-on-one clinical interactions was minimally addressed in the models. Conclusion: Health systems are not only technical, biomedical organizations but also socio-political institutions with goals of financial protection, the fair distribution of services and resources, and the meaningful inclusion of the citizens in the system, and thus patients need to be respected as individuals and as collectives within the healthcare system.

Treatment of Soft-Tissue Necrosis of the Pyriform Sinus Using Pentoxyllifylline and Tocopherol.

Radiotherapy of the head and neck can often lead to complications and side effects, including osteoradionecrosis and soft tissue necrosis. One relatively well-established method of treating osteoradionecrosis includes the PENTOCLO protocol, which consists of Pentoxyllifylline, Tocopherol, and Clodronate. Despite its success in the treatment of osteoradionecrosis, the effectiveness of components of the PENTOCLO protocol in treating soft tissue necrosis of the head and neck is underexplored. This case study reviews the successful treatment of a pyriform sinus ulcer that developed after the use of radiotherapy in treating a T3N2b squamous cell carcinoma. The treatment plan used Pentoxyllifylline and Tocopherol, and omitted Clodronate, and can therefore be referred to as a PENTO protocol.

Development, manufacture and initial assessment of validity of a 3-dimensional-printed bowel anastomosis simulation training model.

BACKGROUND: It is critical that junior residents be given opportunities to practise bowel anastomosis before performing the procedure in patients. Three-dimensional (3D) printing is an affordable way to provide realistic, reusable intestinal simulators. The aim of this study was to test the face and content validity of a 3D-printed simulator for bowel anastomosis. METHODS: The bowel anastomosis simulator was designed and assembled with the use of desktop 3D printers and silicone solutions. The production cost ranges from $2.67 to $131, depending on which aspects of the model one prefers to include. We incorporated input from a general surgeon regarding design modifications to improve the realism of the model. Nine experts in general surgery (6 staff surgeons and 3 senior residents) were asked to perform an anastomosis with the model and then complete 2 surveys regarding face and content validity. Items were rated on a 5-point Likert scale ranging from 1 ("strongly disagree") to 5 ("strongly agree"). RESULTS: The overall average score for product quality was 3.58, indicating good face validity. The average score for realism (e.g., flexibility and texture of the model) was 3.77. The simulator was rated as being useful for training, with an overall average score of 3.98. In general, the participants agreed that the simulator would be a valuable addition to current simulation-based medical education (average score 4.11). They commented that the model would be improved by adding extra layers to simulate mucosa. CONCLUSION: Experts found the 3D-printed bowel anastomosis simulator to be an appropriate tool for the education of surgical residents, based on the model's texture, appearance and ability to undergo an anastomosis. This model provides an affordable way for surgical residents to learn bowel anastomosis. Future research will focus on proving educational efficacy, effectiveness and transfer that can be adapted for laparoscopic anastomosis training, hand-sewing and stapling procedures.