St Michael’s Hospital

Abstract Purpose Considering traditionally poor uptake of video review to support operative skill acquisition, we studied surgical trainees’ perspectives during implementation of the BlackBox Explorer (BBX) video-based teaching and assessment system. Methods This interview study included residents and fellows completing their surgical rotations at a Community Hospital affiliated with the University of Toronto. We used a team-based approach to complete a reflexive thematic analysis. Results Analysis of 11 interviews ( N = 10 residents and N = 1 fellow) generated three themes: (i) Technology is merely a tool, and tools need to work well, (ii) Routinizing a new technology into clinical practice, and (iii) Motivating a new learning practice. Implementation challenges did not dissuade some participants from valuing the BBX. Conclusions We found that a relatively passive ‘implementation by diffusion’ strategy does not lead to uptake in a busy surgical training environment. No matter the potential benefits of any video-based teaching and assessment system, siloed implementation likely breeds inconsistent utilization.

Knee osteoarthritis (OA) and type 2 diabetes (T2D) commonly coexist, but their combined impact on health-related quality of life (HRQoL) remains understudied. We assessed the association between symptomatic knee OA and HRQoL in individuals with T2D and explored potential explanations. We conducted a secondary analysis of a cross-sectional study of individuals with T2D. Symptomatic knee OA was defined using NICE criteria (age ≥45 years, activity-related knee pain, morning stiffness ≤30 min; no inflammatory arthritis). HRQoL (EQ-VAS, 0-100), sleep disturbance (PROMIS Sleep Disturbance 4a), depressed symptoms (PROMIS Depression 8b), fatigue (PROMIS Fatigue 4a), and walking limitation (Health Assessment Questionnaire) were assessed via questionnaire. Linear regression modeled associations between knee OA and HRQoL, adjusting for age, gender, BMI, education, and comorbidities. The explanatory effects of sleep, mood, and mobility were assessed via further sequential adjustment. We included 341 participants: mean age 66.4 years, 51.9 % female, 29.0 % had knee OA. Participants with T2D and knee OA reported lower HRQoL, greater sleep disturbance, fatigue, depressive symptoms, and walking limitations than those without knee OA. Knee OA was associated with lower HRQoL (β = -11.96; 95 % CI: -16.59 to -7.32) in the unadjusted analysis. Adjustment for confounders partially attenuated this effect (β = -8.33; 95 % CI: -12.72 to -3.94). Further adjustment for sleep, mood, and walking limitations fully attenuated the association. Symptomatic knee OA is strongly associated with impaired HRQoL in T2D, explained by sleep disturbance, low mood, and mobility limitation. Integrated care addressing OA may improve quality of life in this population.

OBJECTIVES:Despite advances in critical care medicine, many questions remain unanswered, and existing guidelines are often based on low-quality evidence. This priority setting partnership (PSP), following the James Lind Alliance (JLA) methodology, aimed to identify the top ten research priorities for critical care medicine in Canada based on input from patients, families, and healthcare providers.DESIGN:Three-phase, national, JLA PSP.SETTING:Canada-wide, involving adult and PICUs.SUBJECTS:Patients with lived experience of critical illness, family members of ICU patients, and healthcare providers (physicians, nurses, and allied health professionals).INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:Participants contributed uncertainties through open surveys (phase 1), ranked questions through a national survey (phase 2), and achieved consensus on the final priorities during a virtual workshop (phase 3). Phase 1 included 154 respondents (44 patients/family members, 110 healthcare providers) submitting 509 in scope questions, resulting in 64 unique indicative questions. Phase 2 included 244 participants (63 patients/families, 191 healthcare providers), prioritizing 20 questions to advance to the final workshop. Phase 3 involved 24 individuals (12 with lived experience, 12 healthcare providers) from six provinces, who reached consensus on the top ten research priorities. Briefly, the top three priorities were: 1) improving physical, cognitive, and mental health outcomes post-ICU/PICU; 2) supporting goals-of-care conversations with families; and 3) characterizing short- and long-term post-ICU outcomes and predictors. The full top ten priorities are presented in the article.CONCLUSIONS:This national JLA PSP identified the top ten patient, family, and healthcare provider-driven research priorities for critical care medicine in Canada. These priorities aim to guide future research that is meaningful, inclusive, and evidence-informed.

The aim of this study was to investigate the association of home socioeconomic status (SES) with days at home and survival after treatment of spinal metastases. This population cohort study included all patients in the Ontario Cancer Registry treated from 2007 to 2019 with surgery or radiation therapy (RT) for spinal metastasis. Ordinal categories of SES (SES1-SES5) were defined using home neighborhood material deprivation scores. Outcomes included adjusted median differences (aMD) in the number of days at home and adjusted hazard ratios (aHRs) of mortality for patients of differing SES. Secondary care access outcomes included receiving stereotactic body RT for treatment, the timing of palliative care initiation, and the distance from home to the nearest cancer center. There were 35,896 patients (55% male, mean age 64.4 years) identified; 7397 (21%) resided in relatively resource-deprived neighborhoods and 7080 (20%) resided in relatively resource-affluent neighborhoods. Patients living in the lowest SES neighborhoods had the fewest days at home (SES1 vs SES5, aMD -47) and shortest survival (SES1 vs SES5, aHR 1.14). There was significant mediation attributable to differences in primary cancer (days at home [15.6%], survival [25.7%]) and frailty (days at home [5.9%], survival [7.7%]) between neighborhood SES. Patients residing in lower SES neighborhoods were less often treated with stereotactic body RT (adjusted OR 0.38), had later initiation of palliative care (aHR 0.94), and lived farther from cancer centers (adjusted mean difference 16.5 km). Patients with spinal metastases living in lower SES neighborhoods had fewer days at home and shorter survival, which was partially mediated by differences in primary cancer and possibly posttreatment access to oncology care. These findings will support advocacy efforts championing equity in cancer care.

BackgroundLong COVID affects over 65 million people worldwide, yet the impact of social determinants of health (SDoH), such as socioeconomic status, race/ethnicity, education, occupation, and geography, remains poorly understood. To evaluate the association between SDoH and the risk and severity of Long COVID.MethodsA rapid review of observational studies was conducted using MEDLINE, Embase, and Web of Science (up to September 29, 2024). Studies reporting original data on SDoH and Long COVID outcomes were included. Data were extracted on study characteristics, population demographics, Long COVID definitions, and SDoH-related findings. Study quality was assessed using the Newcastle-Ottawa Scale.ResultsSeventy-one studies (43 cohort, 28 cross-sectional) were included. Definitions of Long COVID varied. Commonly studied SDoH included age, sex, race/ethnicity, education, financial security, employment, and geography. Female sex and older age were consistently associated with increased risk and severity of Long COVID. Black and Hispanic individuals were more likely to experience Long COVID. Lower education and financial insecurity were also linked to greater prevalence and symptom burden. Frontline and essential workers were found to be at increased risk. Geographic disparities were evident but varied across rural and urban residence.ConclusionsSDoH play a key role in shaping Long COVID outcomes. Addressing these disparities requires targeted public health efforts and standardized case definitions.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13690-025-01787-x.

ObjectiveTo evaluate the effects of liberal transfusion strategy (trigger haemoglobin ≤90–100 g/L) compared with a restrictive strategy (trigger haemoglobin ≤70–80 g/L) on long-term neurological functional outcome in anaemic adult patients with acute acquired brain injury (ABI).DesignSystematic review and study-level meta-analysis of randomised controlled trials (RCTs).Data sourcesMEDLINE, EMBASE, Cochrane from inception to 6 February 2025.Study selectionRCTs enrolling patients with acute ABI and anaemia (haemoglobin ≤100 g/L), comparing a liberal vs restrictive transfusion strategy.Data extraction and synthesisTwo reviewers independently identified eligible studies, extracted data and assessed risk of bias. We performed random-effects meta-analysis of RCTs and applied Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the certainty of evidence. Our primary outcome was an unfavourable neurological functional outcome, using the Glasgow Outcome or modified Rankin scales.ResultsFive trials enrolling 2364 patients with acute ABI and anaemia were included in the primary analysis. Liberal transfusion reduces the risk of unfavourable neurological outcome (risk ratio (RR)=0.89, 95% CI 0.84 to 0.95, high certainty). Liberal transfusion may reduce severe disability (RR=0.82, 95% CI 0.66 to 1.02, moderate certainty), and increase good recovery compared with restrictive transfusion (RR=1.29, 95% CI 0.95 to 1.76, low certainty). We found no difference in the risk of most adverse events, including death. Statistical heterogeneity was low (I2=0%–36%) for neurological outcomes.ConclusionsIn adults with acute ABI and anaemia, liberal transfusion reduces the risk of unfavourable outcome (high certainty) and possibly improves the chances of good recovery (low certainty) when compared with restrictive transfusion.PROSPERO registration numberCRD42025628732.

ObjectiveThe 6-minute walk test (6MWT), an Osteoarthritis Research Society International (OARSI)-recommended measure of physical function in knee osteoarthritis (OA), was originally developed to assess submaximal aerobic fitness in people with cardiovascular disease. The degree to which 6MWT performance reflects knee OA severity versus other patient factors remains unclear. Our objective was to assess the contributions of OA-related and non-OA-related patient characteristics to 6MWT performance in individuals with symptomatic knee OA.DesignIn this cross-sectional study, participants scheduled for total knee arthroplasty completed the 6MWT and standardized questionnaires. Participant characteristics were compared by tertiles of 6MWT distance. Multivariable linear regression modelling was used to assess associations between patient factors and 6MWT distance.ResultsAmong 278 participants (mean age 67.1 years, 65.5% female, mean WOMAC pain 57.0, and mean 6MWT distance 323.1m), older age (adjusted beta coefficient -4.0 per year, 95% confidence interval [CI] −5.4, −2.5), female sex (adjusted beta [95% CI] −43.0 [−67.3, −18.7]), presence of obesity (adjusted beta [95% CI] -44.4 [−68.2, −20.5]), greater knee pain (adjusted beta [95% CI] per unit increase in WOMAC pain −1.12 [−2.1, −0.2]), worse knee-OA related function (adjusted beta [95% CI] per unit increase in KOOS-PS −1.1 [−2.0, −0.1]) were associated with shorter 6MWT distance. Greater arthritis coping efficacy (adjusted beta [95% CI] 5.2 [1.4, 9.0]) was associated with longer 6MWT distance.ConclusionsWhile 6MWT distance declines with greater knee OA symptom severity, other demographic, biomedical and psychosocial factors also significantly influence 6MWT performance. These should be considered when interpreting the 6MWT in this population.