Recognizing accomplishments in Research and Innovaon in the Department of Surgery, University of Manitoba 7:45 am—8:45 am Department of Surgery Grand Rounds Theatre C — Bannatyne Campus 9:00 am—5:00 pm Research Day Program Ambassador A — Canad Inns-HSC GRAND ROUNDS SPEAKER Dr Hans Kreder Head, Orthopaedic Division Program Chief, Holland Musculoskeletal Program University of Toronto KEYNOTE SPEAKER Dr Allan Okrainec Head, Division of General Surgery Peter A. Crossgrove Chair in General Surgery University of Toronto
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GRAND ROUNDS SPEAKER KEYNOTE SPEAKER...Mohamed Sharaf Eldin* Head & Neck Surgery 2:15 Impact of necrotizing fasciitis on quality of life Robert Strazar* Plastic Surgery 2:20 lassification
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Recognizing accomplishments in Research and Innovation in the Department of Surgery, University of Manitoba
7:45 am—8:45 am Department of Surgery Grand Rounds
Theatre C — Bannatyne Campus
9:00 am—5:00 pm Research Day Program
Ambassador A — Canad Inns-HSC
GRAND ROUNDS SPEAKER
Dr Hans Kreder Head, Orthopaedic Division
Program Chief, Holland Musculoskeletal Program University of Toronto
KEYNOTE SPEAKER
Dr Allan Okrainec Head, Division of General Surgery
Peter A. Crossgrove Chair in General Surgery University of Toronto
i
Annual Department of Surgery
Research Day 2015
Acknowledgements
The 2015 Surgery Research Planning Committee would like to
acknowledge the Pan Am Clinic Foundation and Department of Surgery
Research Advisory Committee members for their support in the plan-
ning of our Annual Surgery Research Day 2015.
Department of Surgery GFT Surgeons
The Wayne Beecroft Western Surgical Lectureship Fund
Sponsored by
ii
Table of Contents
Research Day Sponsors ............................................................. i
Acknowledgements ................................................................... i
Maintenance of Certificate Program Event Information ......... ii
Visiting Professor Bio ................................................................ iii
Keynote Speaker Bio.................................................................. iv
Judges, Research Day 2015 Planning Committee ..................... v
Disclosure .................................................................................. v
Research Day 2015 Objectives .................................................. vi
Evaluation & Certificate of Attendance ..................................... vi
Program Details—Morning ....................................................... vii
Program Details—Afternoon ..................................................... viii
Participant’s Abstract Index ...................................................... 34
This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of The Royal College of Phy-sicians and Surgeons of Canada and approved by the CPD Medicine Pro-gram, University of Manitoba for a maximum of 7.0 credits.
Participants should only claim credit for the actual number of hours attended.
iii
VISITING PROFESSOR
Dr Hans Kreder
Head, Orthopaedic Division Program Chief, Holland Musculoskeletal Program
Professor, University of Toronto
Dr. Kreder, Head of the Orthopaedic Division and Program Chief of the Hol-land Musculoskeletal Program, has a subspecialty practice in pelvic and ace-tabular reconstruction and hip and knee joint replacement.
He is the first recipient of the Marvin Tile Chair in Orthopaedic Surgery, a member of the Departments of Surgery (Division of Orthopaedics) and Health Policy Evaluation & Management at the University, and an Adjunct Scientist, ICES.
Dr. Kreder is a Professor HPME (Health Policy, Management and Evaluation), Faculty of Medicine, University of Toronto as well as a Professor, Orthopae-dic Surgery, University of Toronto. He works with the Core Faculty, Clinical Epidemiology Program, University of Toronto. He is an AO Trustee, AO North America, and Chair, Medical Advisory Committee.
Dr. Kreder's main research interests involve the measurement of function and other outcomes following traumatic musculoskeletal injuries, arthritic conditions and metastatic disease, as well as policy issues regarding access to care and the effect of provider experience and volume on patient outcome.
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KEYNOTE SPEAKER
Dr Allan Okrainec
Head, Division of General Surgery Peter A. Crossgrove Chair in General Surgery
Associate Professor, University of Toronto
Dr. Allan Okrainec is Head of the Division of General Surgery, and Peter A. Crossgrove Chair in General Surgery at the University Health Network. He is an Associate Professor in the Department of Surgery at the University of To-ronto. His clinical practice specializes in minimally invasive gastrointestinal and bariatric surgery.
Dr. Okrainec is the Director of the Temerty/Chang International Centre for Telesimulation and Innovation in Medical Education. His research interests include the use of simulation and telesimulation for the teaching and assess-ment of laparoscopic skills and the assessment of clinical outcomes and en-hanced recovery programs after surgery. He has published widely and has given numerous invited lectures both nationally and internationally. His work is supported by several research grants, including the Center of Excel-lence in Surgical Education, Research and Training, and Grand Challenges Canada Stars in Global Health.
Dr. Okrainec has leadership roles in several national and international surgi-cal societies. He currently serves on the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons.
v
Judges
Dr Allan Okrainec
Associate Professor Department of Surgery, University of Toronto Dr Hans Kreder
Professor Department of Surgery, University of Calgary Dr Markus Ziesmann
General Surgery Resident Department of Surgery, University of Manitoba
Research Day 2015 Planning Committee
Dr Ted Tufescu, Co-Chair
Dr Krista Hardy, Co-Chair
Dr Richard Keijzer, Thorlakson Chair in Surgical Research
Dr Christopher White, Resident Representative
Mary Brychka, Administrator
Disclosure
Before each presentation, speakers will disclose on their first slide any significant relationships that may be a perceived or apparent conflict of interest to the subject of the proposed CME/CPD activity.
Each member of the Research Day 2015 Planning Committee were asked to disclose any significant relationships with the manufacturer of any commercial product that may have a direct or indirect conflict of interest in the program content. All members reported no conflicts
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Research Day 2015 Objectives
At the end of the Department of Surgery Annual Research Day, participants will be able to:
Discuss the findings from surgical research conducted in the Depart-ment of Surgery at the University of Manitoba with colleagues and translate knowledge into clinical practice, patient care and academic teaching.
Understand why simulation is an important component in surgical training; describe the benefits of distance learning in resource-restricted settings; and outline both successes and challenges in es-tablishing an international surgical education and research program.
Understand the effect of surgical skill on outcomes; how to monitor and improve quality; and to consider possible educational models to address the learning curve.
Evaluation & Certificate of Attendance
The Royal College’s Maintenance of Certification program requires that all
accredited activities be evaluated. Your input is invaluable to help us
know this event met your expectations; where there is room to improve;
and to enrich the Department of Surgery’s Annual Research Day for sur-
geons, fellows, residents, medical students, researchers and staff.
Upon completion of your evaluation, the Certificate of Attendance will be
accessible to print for your records. Instructions have been provided on
the website and an email reminder will be sent to all participants following
the event.
We appreciate your support and thank you for your time and collabora-
tion.
Thank you.
Today’s sessions will be evaluated electronically through the Department of
7:45 DEPARTMENT OF SURGERY GRAND ROUNDS Visiting Professor: Dr Hans Kreder, University of Toronto Surgical complications & outcomes: The effect of surgeons, hospitals and systems of care Theatre C – Bannatyne Campus—University of Manitoba
9:00 OPENING REMARKS - Dr Ted Tufescu (Co-Chair) Ambassador Room A (second floor) Canad Inns – Destination Health Sciences Centre
PLENARY SESSION Moderator: Dr Sadeesh Srinathan
Time Abstract Title Presenter
9:15 General vs. technique specific technical skills assessments – The wheel rein-vented
Sarah Steigerwald* General Surgery
9:26 Outcomes in adult survivors of childhood burn injuries as compared to matched controls
James Stone* Plastic Surgery
9:37 Vestibulo-ocular dysfunction in pediatric sports-related concussion Michael Ellis Neurosurgery
9:48 Comparison of left and right laparoscopic living donor nephrectomies: A Cana-dian single centre experience
Claire Gardiner* Urology
9:59 The DISCERN Study: Mid-term follow-up of post-operative health-related quality of life and mental health status in patients undergoing cardiac surgery
Quyen Nguyen* Cardiac Surgery
10:10 Targeting HMGA2-mediated chemoresistance in GB using DNA minor groove binding drugs
Suchitra Natarajan* Human Anatomy
10:21 The AVATAR Trial: Applying VAcuum To Accomplish Reduced wound infections in laparoscopic pediatric surgery
Robin Visser* Pediatric Surgery
10:32 COFFEE BREAK (15 minutes)
PLENARY SESSION Moderator: Dr Rakesh Arora
Time Abstract Title Presenter
10:47 Avoidance of profound hypothermia during initial reperfusion improves the functional recovery of DCD hearts
Christopher White* Cardiac Surgery
10:58 Normalizing miR-200b expression in vivo improves nitrofen-induced lung hypoplasia in the rat model of congenital diaphragmatic hernia
Naghmeh Khoshgoo* Pediatric Surgery
11:09 Microsurgical reconstruction with ambulation preservation following lower extremity sarcoma resection
Colin McInnes* Plastic Surgery
11:20 Ultrasound assessment of optic nerve sheath diameter (ONSD) in healthy volunteers
Patrick Goeres* General Surgery
11:31 Renal nephrometry score and predictors of pathologic upstaging in patients undergoing partial and radical nephrectomies
Deepak Pruthi* Urology
11:42 Comparison of percutaneous fixation versus open reduction and internal plate fixation for the treatment of calcaneal fractures
Ricky Muller Moran* Orthopedic Surgery
11:53 Genesis II SPC / Legion mid-term survivorship Alistair Ross Demcoe* Orthopedic Surgery
12:04 The effect of rater training on trainee assessments in medical education: A systematic review
Reagan Maniar* General Surgery
12:15 LUNCH
12:45 AWARDS CEREMONY Presented by Dr Jack McPherson, Head & Dr Richard Keijzer, Thorlakson Chair in Surgical Research 2014 Resident Research Awards & 2014 Annual Department of Surgery GFT Research Awards
* Speaker eligible for a presentation award
viii
1:00 INTRODUCTION Dr Krista Hardy (Co-Chair) KEYNOTE SPEAKER Dr Allan Okrainec, University of Toronto Developing & delivering an international surgical education program: Lessons learned from around the world
BRIEF SESSION Moderator: Dr Ashley Vergis
Time Abstract Title Presenter
2:00 Computational fluid dynamics analysis of pulsatile flow in non-ruptured abdominal aortic aneurysms: A correlation between aortic hemodynamics and aortic matrix metalloproteinases
Annie Ducas* Vascular Surgery
2:05 Utility of pre-operative magnetic resonance imaging in the prediction of prostate adenocarcinoma disease burden
Jennifer Bjazevic* Urology
2:10 Ultrasound imaging of nodal metastases in the central compartment in differentiated thyroid cancer: Is it possible to increase sensitivity?
Mohamed Sharaf Eldin* Head & Neck Surgery
2:15 Impact of necrotizing fasciitis on quality of life Robert Strazar* Plastic Surgery
2:20 Classification of facial pain: A 13-year population-based longitudinal study Lyra de Fatima Barchet* Neurosurgery
2:25 In vivo micromotion comparison of keeled versus pegged glenoid in a total shoulder replacement: A two-year radiostereometric analysis study
Peter MacDonald Orthopedic Surgery
2:30 Transanal endoscopic microsurgery for giant rectal polyps Courtney Chernos* General Surgery
2:35 Early and late continence after bladder neck sparing radical prostatectomy Chun Huang* Urology
2:40 Comparison of physical fitness between surgical and non-surgical residents David Perrin* Orthopedic Surgery
2:45 A randomized clinical trial comparing the breast and abdominal related morbidity of DIEP and SIEA flaps
Blair Peters* Plastic Surgery
2:50 Neuro-imaging findings in pediatric sports-related concussions: A clinical study
Thomas Hall* Neurosurgery
2:55 The impact of body position and walking on neurophysiological outcome measure
Mina Aziz* Orthopedic Surgery
3:00 COFFEE BREAK (15 minutes)
PLENARY SESSION Moderator: Dr Patricia Larouche
Time Abstract Title Presenter
3:15 Characteristics, long-term survival and predictors of mortality of patients needing prolonged intensive unit care stay post cardiac surgery
Rizwan Manji Cardiac Surgery
3:26 Shit happens: Integrated knowledge translation to identify and prioritize knowledge needs faced by Hirschsprung’s Disease families
Kendall Hobbs-Murison Pediatric Surgery
3:37 Mental and physical health outcomes in parents of children with burn injuries as compared to matched controls
Jessica Enns* Plastic Surgery
3:48 The impact of lumbar spinal stenosis on lower extremity motor control: A pre-surgical study
Austin Enright* Orthopedic Surgery
3:59 Non-neoplastic kidney and predictors of post-operative renal insufficiency in radical nephrectomies
Ruchi Chhibba* Urology
4:10 Arthroscopic versus open lateral release for the treatment of lateral epicon-dylitis: A prospective randomized controlled trial
Jamie Dubberley Orthopedic Surgery
4:30 RESEARCH DAY RECEPTION & PRESENTATION AWARDS Presented Dr Richard Keijzer, Thorlakson Chair in Surgical Research Come and celebrate with the winners of today’s top presentations
1
General vs. technique specific technical skills assessments –
The wheel reinvented
Sarah Steigerwald, Jason park, Krista Hardy, Lawrence Gillman, Ashley Vergis
(Section of General Surgery, Department of Surgery, University of Manitoba)
Introduction
Reliable and valid methods of evaluating operative performance are essential for
surgical training programs and education research. Laparoscopic surgery entails a
unique skill set, but it is unclear whether it requires a specific assessment form or
whether more general assessment tools can be applied. The purpose of this study
was to assess the reliability and construct and concurrent validity of two previously
validated assessment scales. One of these scales was designed specifically to assess
laparoscopic skills, and the other to assess more general surgical skills.
Methods
32 PGY 1 – 5 general surgery and urology residents performed a live human laparo-
scopic cholecystectomy. Three attending surgeon raters scored their performance
using the previously well-validated Objective Structured Assessment of Technical
Skills (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS) global
rating scales.
Results
OSATS and GOALS demonstrated reliability with a Cronbach’s alpha of 0.958 and
0.959 respectively. Construct validity was demonstrated for both GOALS and OSATS
with senior residents demonstrating significantly higher scores than the junior group
(p<0.001). Pearson’s correlation coefficient between GOALS and OSATS was 0.975
(p=0.01).
Conclusion
Reliability and construct validity were confirmed for both GOALS and OSATS global
rating scales. The near total correlation between the two scales questions the need
for separate laparoscopic assessment tools. This study highlights the real strengths
of the original OSATS forms, the use of which allows for more consistent nomencla-
ture and standardized skills assessment across surgical platforms.
2
Outcomes in adult survivors of childhood burn injuries as compared to matched controls
James Stone1, JP Gawaziuk2,3, S Khan4, D Chateau4, J Bolton5, J Sareen5, J Enns1, M Doupe4,
M Brownell4, S Logsetty2,3
(1BSc Med Program, 2Manitoba Firefighters Burn Unit, 3Department of Surgery (Section of Plastic Surgery), 4Manitoba Centre for Health Policy, 5Department of Psychiatry)
Introduction
Limited research exists examining long-term mental and physical health outcomes in
adult survivors of pediatric burn injuries. We examine the post-injury lifetime preva-
lence of common DSM-IV mental and physical disorders in a population based pedi-
atric burn cohort compared to matched controls.
Methods
748 survivors of childhood burns were identified from the Winnipeg Children’s Hos-
pital burn registry (between April 1, 1988 - March 31, 2010 with burn TBSA >1%).
These individuals were matched 1:5 to children from the Manitoba general popula-
tion based on age, sex and geographic residence. Post-burn prevalence and Odds
Ratio (OR) comparisons of common Axis 1 mental and physical disorders were done.
The diagnoses were made through physician billings, hospital claims and clinical data
housed at the Manitoba Center for Health Policy Data Repository.
Results
The burn cohort was 5.43 ± 5.02 years old (mean ± SD) with a % TBSA of 11.94 ±
12.03 (mean ± SD). In burn survivors, anxiety was the most prevalent Axis 1 mental
disorder (22.59%), followed by major depression (14.17%), substance abuse/
dependence (3.21%) and suicide attempts (1.2%). Total respiratory morbidity was
the most prevalent physical disorder in burn survivors (51.34%), followed by arthritis
(36.50%), fractures (30.21%), diabetes (3.61%) and cancer (1.47%). Compared to
controls, the burn cohort showed a significant increase in major depression (OR =
1.76; CI 1.39-2.22), anxiety (OR=1.74; CI 1.44-2.12), substance abuse/dependence
(OR=2.85; CI 1.71-4.73), suicide attempts (OR=5.68; CI 2.18-14.7), arthritis (OR=1.33;
CI 1.13-1.56), cancer (OR=2.05; CI 1.01-4.16), diabetes (OR=1.71; CI 1.09-2.67), frac-
tures (OR=1.73; CI 1.46-2.07) and total respiratory morbidity (OR=1.57; CI 1.32-1.84).
Conclusion
Adult survivors of childhood burns injury report significantly more frequent Axis 1
mental and physical health outcomes. Screening for these illnesses is essential when
caring for this population.
3
Vestibulo-ocular dysfunction in pediatric sports-related concussion
Michael J Ellis1,3,4,5, Dean Cordingley4, Sara Vis4, Karen Reimer4, Jeff Leiter1,4, Kelly Russell2,5
(1Department of Surgery, 2Department of Pediatrics & Child Health, 3Section of Neurosurgery, 4Pan Am Clinic,
5Children’s Hospital Research Institute of Manitoba, Canada North Concussion Network)
Introduction
The objective of the present study was two-fold: 1.) to examine the prevalence of
vestibulo-ocular dysfunction (VOD) among children and adolescents with sports-
related concussion(SRC) or post-concussion syndrome (PCS) referred to a multi-
disciplinary pediatric concussion program. 2.) to determine if VOD is associated with
the development of PCS in this cohort.
Methods
We conducted a retrospective review of all SRC (presenting 30 days or less post-
injury) and PCS patients(3 or more symptoms for at least 1 month) referred to a
multi-disciplinary pediatric concussion program between September 2013 and July
2014. Initial assessment included clinical history, physical examination, and Post-
Concussion Symptom Scale assessment. Patients were also assessed for VOD defined
as more than one subjective vestibular and oculomotor complaint (dizziness, blurred
vision etc.) and more than one objective physical examination finding (abnormal
smooth pursuits, saccades, vestibulo-ocular reflex etc.). This study was approved by
Avoidance of profound hypothermia during IR minimizes injury and improves the
functional recovery of DCD hearts.
9
Normalizing miR-200b expression in vivo improves nitrofen-induced lung hypoplasia in the rat model of congenital diaphragmatic hernia
Naghmeh, Khoshgoo1,2,3, Patricia Terra1,2, Barbara Iwasiow1,2, Fuqin Zhu1,2, Robin Visser1,2, Vinaya Siragam1,2, Richard Keijzer1,2,3
(1Children’s Hospital Research Institute of Manitoba, 2Department of Surgery, 3Department of Physiology & Pathophysiology)
Introduction
We have previously discovered that microRNA miR-200b expression is lower in nitro-
fen-induced hypoplastic lungs. In this study we test the hypothesis that normalizing
miR-200b expression improves lung development in the nitrofen rat model for con-
genital diaphragmatic hernia (CDH).
Methods
We induced pulmonary hypoplasia and CDH by gavaging five pregnant Sprague-
Dawley rats with 100 mg/ml nitrofen in olive oil. Two control rats were treated with
olive oil alone. Immediately after this treatment, we injected the pregnant nitrofen-
treated rats with 5 mg/kg miR-200b mimics in normal saline (three) or normal saline
alone (two). Newborn rats were euthanized when in distress or one hour after birth.
Lungs were insufflation-fixated with 4% PFA and processed for morphometry and
immunohistochemistry. Statistical comparisons were done using a one-way ANOVA-
Bonferroni test (p<0.05 was significant).
Results
We observed a 70% CDH incidence in the nitrofen pups treated with normal saline.
This was reduced to 15% in the nitrofen rats treated with miR-200b mimics. The
majority of the nitrofen pups treated with saline were suffering from severe respira-
tory distress and euthanized within 10 minutes, whereas all pups treated with miR-
200b mimics displayed no respiratory distress and were euthanized after 10
minutes. Histology and morphology of lungs in nitrofen pups treated with miR-200b
mimics improved. Radial alveolar count was significantly higher (p=0.016) after miR-
200b treatment.
Conclusion
Normalizing miR-200b expression in pregnant rats treated with nitrofen improves
lung development in the offspring clinically and morphologically. Translational stud-
ies in larger animal models should reveal if these promising results could eventually
be extrapolated to human clinical trials.
10
Microsurgical reconstruction with ambulation preservation following lower extremity sarcoma resection
Colin McInnes, I. MacArthur, Edward W. Buchel, Thomas Hayakawa
(Section of Plastic Surgery, Department of Surgery, University of Manitoba)
Introduction
Lower extremity sarcoma treatment has evolved from primarily amputation towards
limb salvage when possible to preserve ambulation. Sarcoma resections frequently
result in massive soft tissue defects which usually require microsurgical reconstruc-
tion. Traditionally, success has been defined as having flap survival in the hostile
conditions of a radiated surgical field. This series investigates whether these tissue
defects can be reliably reconstructed with preservation of ambulation, and moreo-
ver, if immediate functional muscle free-flap reconstructions can be successful when
required to preserve ambulation.
Methods
A 5-year retrospective review of microsurgical reconstruction for limb salvage in
lower extremity sarcoma patients was conducted at the University of Manitoba.
Outcome measures included limb salvage rates, type of flap(s) utilized, ambulation
preservation and patient function utilizing the Toronto Extremity Salvage Score
(TESS), and complications, among others.
Results
Over a five-year period, 22 patients (average age 52 years) underwent free flap re-
construction following lower extremity sarcoma resection with an average follow-up
of 14 months. Of those, 85% underwent neo-adjuvant radiation therapy. The thigh
was the most common tumour site (57%) and 3 different muscles were resected on
average. Perforator flaps were used in the majority of reconstructions (68%), and
functional muscle transfers or immediate tendon transfers were used in 3 patients.
The average TESS scores was 84. There were no flap failures, and all patients
achieved ambulation. Two patients in the series died from metastatic disease (not
local recurrence).
Conclusion
Microsurgical reconstruction of lower extremity sarcoma defects enabling preserva-
tion of ambulation is usually successful and must be considered the gold standard,
replacing the traditional goal of achieving adequate soft tissue coverage alone.
Preservation of function utilizing functional microsurgical reconstructions should
now be considered safe, effective, and as first line treatment in limb salvage proce-
dures. These results may expand the indications for limb salvage in otherwise bor-
derline cases.
11
Ultrasound assessment of optic nerve sheath diameter (ONSD) in healthy volunteers
Patrick Goeres1, Frederick A. Zeiler2, Bertram Unger,3 Lawrence M. Gillman4
(1UGME-University of Manitoba, 2Section of Neurosurgery, 3Department of Medical Education, 4Section of General Surgery)
Introduction
Ultrasonic assessment of optic nerve sheath diameter (ONSD) has been suggested as
a potential non-invasive technique for the measurement of intracranial pressure
(ICP). Numerous small studies exist defining its validity as a means to quickly deter-
mine elevated ICP. However, discrepancy exists around what a normal value is for
ONSD due to a lack of standardized measurement technique, and only a small num-
ber of studies mostly in unhealthy patients with normal invasive ICP measurements.
In this study we sought to define a normal value range for ONSD in a large popula-
tion of healthy adult volunteers using a standardized measurement technique.
Methods
ONSD was measured using a standardized technique in healthy adult volunteers and
a normal range was defined using descriptive statistics. Pearson’s correlation was
used to determine relationship between ONSD measurements and sex, age, height
and weight.
Results
62 adults were recruited ranging in age from 19 to 65 (mean 29.5) with 50% being
male. Mean ONSD was 38.3 (33.1-45.8 95% confidence Interval (CI)) in the left eye,
and 38.0 (31.8-44.4 95% CI) in the right eye. Mean ONSD did not vary with age but
did vary significantly with weight, height and sex. However, when controlling for sex,
weight and height no longer contributed to ONSD measurements. Mean ONSD
measurements for males were 39.8 (34.9-45.8 95% CI) compared with 36.5 (28.6-
41.0 95% CI) for females.
Conclusion
This study has defined the range of ONSD in a healthy cohort of volunteers. The
determined range and lack of relationship to age, weight and height is similar to
other studies in the literature but this is the first study to find a difference in sex
amongst ONSD measurements suggesting the possible need for modified reference
ranges for males and females.
12
Renal nephrometry score and predictors of pathologic upstaging in patients undergoing partial and radical nephrectomies
Deepak Pruthi1, Ruchi Chhibba2, Darrel E. Drachenberg1, Thomas B. McGregor1
(1Section of Urology-Department of Surgery and 2UGME-College of Medicine, University of Manitoba)
Introduction
To examine the predictive capability of pre-operative anatomic imaging characteriza-
tion using the R.E.N.A.L. Nephrometry Score (RNS) in assessing pathologic upstaging
of clinical T1 (cT1) lesions to pathologic T3 (pT3) in partial and radical nephrectomy
specimens.
Methods
A retrospective review of all patients undergoing radical and partial nephrectomies
between January 1, 2011 and May 31, 2014 for cT1 renal masses. All pre-operative
imaging scans were reviewed and the R.E.N.AL. Nephrometry score (radius for tumor
size as maximal diameter, exophytic/endophytic tumor properties, nearness of
deepest portion of tumor to collecting system or sinus, anterior/posterior descriptor
and location relative to polar line) was applied to each scan. Chi-square, Fisher exact
test, and Student t test were utilized to examine associations.
Results
Of the 229 patients who underwent partial or radical nephrectomy for cT1, 124
(54%) underwent partial nephrectomy. On pathologic evaluation 195 (85%) patients
had malignancy. Of all tumors 26 (13%) were pathologically upstaged to pT3 with
the majority attributable to renal sinus/fat (35%) or perinephric fat (31%) involve-
ment. High RNS (>10) was significant in predicting pathologic T3 upstaging (p=0.039)
but did not predict high grade (Furhman grade 3-4) disease (p=0.803). While a high
nephrometry score trended toward predicting malignancy vs benign disease
(p=0.086), a higher mean nephrometry score (7.81 vs 6.84) significantly predicted
malignancy (p=0.015). When controlled for cT1a lesions, tumor location relative to
polar lines (L=3 vs L1+2) was predictive of pT3 upstaging (24 vs 6%, p=0.03). Age >65
was significantly associated with upstaging (26 vs 7%, p=0.0001).
Conclusion
Surveillance of small renal masses is common but high RNS and age >65 significantly
predicted upstaging. Mean nephrometry score was also useful in predicting malig-
nancy. Nephrometry score may aid in deciding on early surgical intervention.
13
Comparison of percutaneous fixation versus open reduction and internal plate fixation for the treatment of calcaneal fractures
Ricky Muller Moran, Ted Tufescu, Allan Hammond
(Section of Orthopedic Surgery, Department of Surgery, University of Manitoba)
Introduction
Although calcaneal fractures are common and often associated with significant mor-
bidity, there is a controversy between open reduction and internal fixation using a
calcaneal plate (ORIF), versus minimally invasive techniques of percutaneous fixation
(PF) as the superior operative treatment method. The primary objective of this study
was to measure the rate of post-operative complications with both types of treat-
ment. Secondary objectives included measuring the quality and maintenance of
fracture reduction with each technique, and clinical outcome of patients who re-
ceived each type of treatment.
Methods
A retrospective review of 82 consecutive patients treated for calcaneal fractures at a
level I trauma centre during the years of 2011 to 2014 was conducted. Radiographic
outcomes were measured pre-operatively, peri-operatively (defined as either intra-
operatively or up to three weeks post-operatively), and at last follow-up. This includ-
ed measuring Bohler’s angle at all three time points and assessment of the subtalar
joint at the latter two time points. Functional outcomes were measured using the
Short-Form 12, Foot Function Index, and Foot & Ankle Ability Measure health sur-
veys.
Results
Of the 82 consecutive patients, three did not meet the inclusion criteria. 87 calcane-
al fractures were identified in the remaining 79 patients (ORIF n = 18, PF n = 69). No
significant difference was found between the two operative groups in terms of ei-
ther radiographic or functional outcome. Time to surgery was significantly higher in
the ORIF group (10.6 days ORIF versus 3.27 days PF, P = 0.0002). Post-operative com-
plication rates were 40% with ORIF versus 7.41% with PF; this was not a statistically
significant difference (P = 0.11).
Conclusion
The trend that we have identified supports the hypothesis that PF is associated with
a lower complication rate. This study was limited by the small ORIF group; further
investigation with a larger sample size is warranted.
14
Genesis II SPC / Legion mid-term survivorship
Alistair Ross Demcoe, Thomas Turgeon, Colin Burnell, Eric Bohm
(Concordia Hip & Knee Institute, Section of Orthopedic Surgery, Department of Surgery,
University of Manitoba)
Introduction
The Genesis II total knee implant system was released to the general market in 1996
and experienced good overall performance. Design variations were introduced into
the system in 2005, which utilized a symmetrical posterior condyle design. This sys-
tem, initially known as the Genesis II SPC, and later as the Legion Primary, has not
been evaluated for implant performance and survival. The aim of this study was to
report on the mid term survivalship of the Genesis II SPC/Legion primary TKA at a
single institution.
Methods
The institution’s ethics review board approved the study. Legion/Genesis II SPC TKAs
implanted at the study centre from March 2007 to August 2012 by four fellowship
trained arthroplasty surgeons were included. Patients were consented and enrolled
into a prospective database. Patient’s age at time of surgery, height and weight were
all recorded. The database was retrospectively reviewed and survival analysis was
undertaken using Kaplan-Meier techniques.
Results
There were 2170 patients with 2814 primary total knee arthroplasties with a mini-
mum of 2 year follow up available in the database for analysis. The mean age was
64.6 (19.2-102.0) years, average BMI was 34.9 (14.8-75.7), and 63.0% of the knees
were performed in female patients. The Kaplan-Meier analysis demonstrated a 2-
year survival of 98.2% (95 % CI 97.7-98.6%) for failure for any reason, and a 5 year
survival rate of 97.0% (95% CI 96.2-97.7%).
Conclusion
The Genesis II SPC/Legion Primary system offers excellent midterm survivorship.
Confirmation of these findings using registry data is warranted.
15
The effect of rater training on trainee assessments in medical education: A systematic review
Reagan Maniar, Ashley Vergis, Lawrence Gillman, Krista Hardy, Jason Park
(Section of General Surgery, Department of Surgery, University of Manitoba)
Introduction
Rater training is commonly used in non-medical disciplines to improve the reliability
and accuracy of assessments. Many standardized assessment tools have been devel-
oped for medical education purposes but the benefit of rater training in this context
is unclear. We conducted a systemic review to examine the effect of rater training
on trainee assessments in the medical education literature.
Methods
We searched PubMed, MEDLINE, EMBASE, The Cochrane Library, CINHL, ERIC and
PsychInfo for original publications until March 2014. Inclusion criteria were: prospec-
tive studies with rater training for physicians as a primary intervention compared to
some type of controls.
Results
Eleven studies met the inclusion criteria. The studies evaluated rater training on a
wide variety of skills and assessment tools, with marked heterogeneity in the meth-
ods and type of rater training. Five studies examined inter-rater reliability, four ex-
amined accuracy, one examined construct validity, and two examined evaluation
quality. Four studies showed a significant effect of rater training on reliability, accu-
racy and quality (two studies). Most studies were of low to moderate quality, but
one high quality RCT showed a significant effect of rater training on the inter-rater
reliability of clinical skill evaluations that persisted for eight months.
Conclusion
The effect of rater training on assessments of medical trainees remains unclear given
the current evidence. Additional high quality studies are warranted to determine if
rater training can improve assessments in medical and surgical education, such as
those for technical skills assessments.
16
Computational fluid dynamics analysis of pulsatile flow in non-ruptured abdominal aortic aneurysms: A correlation between aortic hemodynamics
and aortic matrix metallopreteinases
Annie Ducas1, Richard Lozowy2, David Kuhn,3 Thomas Klonisch4, April Boyd1
(1Section of Vascular Surgery, Department of Surgery, 2PhD candidate, 3Faculty of Engineering, 4Department of Human anatomy & Cell Sciences)
Introduction
Currently, there is no truly reliable way to evaluate the susceptibility of particular
abdominal aortic aneurysms (AAA) to rupture. In order to elucidate the pathogene-
sis of AAA, a correlation of aortic blood flow with aortic wall composition might vast-
ly improve understanding the development, growth and rupture of AAA.
Methods
We numerically simulated aortic blood flow in non-ruptured AAA using Open-Foam
computational fluid dynamics software. Intra-aortic areas of high and low wall shear
stress (WSS) were identified in laminar and pulsatile flow states. At the time of open
repair, redundant aortic tissue and thrombus samples were harvested throughout
the aorta. Tissue was assessed histologically for inflammatory cell content, as well
as collagen and elastin content. Immunohistochemistry was used to identify Matrix
Metalloproteinase—9 (MMP-9) levels active and non-active forms. Colorimetric and
Western-blot analysis was used to quantify MMP-9 enzymes at different locations in
the aorta. The composition of the AAA wall at sampling sites was correlated with
WSS at each location.
Results
To date, 16 patients have been enrolled in the study and aortic tissue samples have
been collected. Analysis of histological changes and MMP-9 levels are underway.
The computational fluid dynamics models have been generated for each AAA
demonstrating the regions of high and low WSS under pulsatile flow conditions.
Conclusion This work may improve our understanding of the interaction between the me-chanical effect of shear and the local biological factors responsible for AAA wall de-generation and rupture.
17
Utility of pre-operative magnetic resonance imaging in the prediction of prostate adenocarcinoma disease burden
Jennifer Bjazevic, Kamaljot Singh Kaler, Rebekah Rittberg, Jeffery Walter Saranchuk, Darrel E. Drachenberg
(Section of Urology, Department of Surgery, University of Manitoba)
Introduction
Magnetic resonance imaging (MRI) of the prostate is becoming increasingly utilized
in the preoperative assessment of patients prior to radical prostatectomy (RP) for
prostate adenocarcinoma. However, the predictive ability of prostate MRI to detect
disease extent varies significantly in the published literature. Following its introduc-
tion at a single institution, we evaluated the predictive capability of MRI prostate to
determine burden of disease.
Methods
24 patients who underwent preoperative MRI prostate imaging prior to RP were
retrospectively reviewed. Imaging was completed at the discretion of the surgeon
based on clinical and pathological features. All MRIs were reviewed for positive
findings and correlated with final pathologic specimens. Sensitivity and specificity of
MRI in predicting tumor location, extracapsular extension (ECE), seminal vesicle
invasion (SVI), and lymphadenopathy was calculated.
Results
21 (87.5%) patients had carcinoma of the prostate present on MRI imaging. MRI
correctly predicted positive lymphadenopathy in a single patient; however, 10
(41.7%) patients with no lymphadenopathy on MRI had positive pelvic lymph nodes.
MRI predicted 4 (16.7%) patients had SVI, and 2 (50%) of these patients had positive
SVI on pathology. 7 (29.2%) patients were not predicted to have SVI on MRI and had
positive seminal vesicles. For SVI, preoperative MRI had a sensitivity and specificity
of 22.2% and 86.7% respectively. 6 (25.0%) patients had ECE present on MRI and 5
(83.3%) of these patients were confirmed to have ECE on final pathology. 10
(41.7%) patients with no evidence of ECE on MRI had positive ECE. MRI imaging has
a sensitivity of 33.3% and a specificity of 88.9% for predicting ECE.
Conclusion
Preoperative prostate MRI can provide valuable information for treatment decisions
and operative planning. However, the ability of MRI to accurately predict ECE, SVI,
and lymphadenopathy is still limited.
18
Ultrasound imaging of nodal metastases in the central compartment in differentiated thyroid cancer: Is it possible to increase sensitivity?
(iTn), MS- or tumor-related trigeminal neuropathy, idiopathic or atypical facial pain
(IFP), and a variety of other craniofacial pain conditions. For this study we reviewed
clinical records and further assigned diagnoses according to published classification
schemes for comparisons.
Results
A total of 544 FP patients were assessed. The most common diagnosis was tTN in
301 patients (55%) with diagnostic criteria equivalent to IHS-III classical trigeminal
neuralgia, purely paroxysmal (13.1.1.1) and IASP trigeminal neuralgia (tic doulou-
reux) (II-1). An additional 24 patients (4%) had aTN, equivalent to IHS-III classical
trigeminal neuralgia with concomitant persistent facial pain (13.1.1.2). Additional 39
patients (7%) had iTn without corresponding criteria in IHS-III or IASP. The Burchiel
classifications of TN-1and TN-2 had criteria encompassing but not differentiating
tTN, aTN and iTn. Other diagnoses included MS-related trigeminal neuralgia in 5%
(not differentiated from tTN in IASP), tumor-related trigeminal neuralgia in 1%, IFP in
10% and other craniofacial pain diagnoses in 18%.
Conclusion
Classification of FP is optimally based upon the underlying pathophysiology. The IHS-III is closest to achieving this aim among the published criteria, although does not account for iTn. Neurosurgeons offering trigeminal neuralgia treatment must be well versed in the differential diagnoses of FP, as only two-thirds of referred patients had conditions potentially amenable to surgical intervention.
21
In vivo micromotion comparison of a keeled versus pegged glenoid in a total shoulder replacement: A two-year radiostereometric analysis study
Peter MacDonald1, Sheila Mcrae1, Trevor Gascoyne2, Jeff Leiter1, Martin Petrak2, Eric Bohm2
(1Section of Orthopedic Surgery—Pan Am Clinic, Department of Surgery, University of Manitoba and 2Concordia Hip & Knee Institute)
Introduction
Our primary objectives were:
- To establish the validity and reliability of RSA to measure glenoid micromotion;
-To measure the translational and rotational micromotion of the glenoid compo-
nents of the pegged and keeled design as measured by RSA;
- Compare the two groups with respect to patient reported quality of life.
Methods
An RSA phantom study was performed prior to the clinical trial to determine appro-
priate marker placement and accuracy of the system. Then, fifteen participants (1
bilateral) were randomized to receive either the pre-marked pegged or keeled gle-
noid design (Biomet Orthopaedics, Warsaw, IN). Five to ten tantalum markers were
inserted during surgery. RSA exams, physical assessment, and three subjective out-
come scores were completed at 6 weeks, 6-, 12-, and 24-months post-surgery. Sig-
nificance was set as p < 0.05.
Results
From the TSA phantom, the translational precision and accuracy was better than 20
microns in any direction and the precision (zero-displacement between glenoid com-
ponent and scapula) was better than 10 microns in any direction. Ten men (one
bilateral) and five women with mean age of 64 years participated. No differences
were detected between the pegged versus keeled designs in terms of rotation or
translation. Some patients showed high early migration of the glenoid component;
however, this may be a result of a lack of visible markers causing large errors in mo-
tion. All subjective outcome scores (WOOS, ASES, SST), improved significantly for
both study groups from pre- to post-surgery. No differences in subjective measures
between groups were detected at any post-surgery time points.
Conclusion
No statistical differences were found between the pegged versus keeled glenoid
fixation styles in patient quality of life, which is consistent with one previous study,
but not another. Overall, we were not able to infer any trends or patterns in vivo
motion for either component.
22
Transanal endoscopic microsurgery for giant rectal polyps
Courtney Chernos1, Elise Crocker2, David J. Hochman1
(1Section of General Surgery, Department of Surgery, University of Manitoba
and 2BSC Med Student Program)
Introduction
Historically, patients with complex rectal lesions not amenable to complete endo-
scopic resections required radical surgical excision. Giant polyps, defined in the liter-
ature as lesions greater than 4 x 4 cm in dimension, are a particularly difficult subset
of polyps. With the advent of Transanal Endoscopic Microsurgery (TEM) surgery we
are now able to achieve full curative resection with a minimally invasive surgical
technique. This case series examines the outcomes of patients with giant rectal
polyps following TEM resection.
Methods
Between May 2009, and February 2014, 164 patients underwent TEM surgery for
rectal lesions in Manitoba. All patients who met the criteria of a giant rectal lesion,
defined as lesions greater than 16 cm² in area were included in the analysis, focusing
on completeness of resection, quality of specimen excision and recurrence rates.
Results
80 patients (48.8%) underwent TEM surgery for a giant rectal lesion. The average
size of the lesions was 31.1 cm2 in area (16.2 - 73.5). The average height of the le-
sion from the anal verge was 9.6 cm. Lesions were removed with full thickness exci-
sion in 77 (96%) cases and had negative resection margins in 67 (84%). Pathology
identified unanticipated malignancy in 16 patients (20%). Recurrences were noted in
7 (8.8%) cases, mean time to recurrence was 17 months (8-25). The mean follow-up
interval was 8 months (0-34). Procedural complications occurred in a total of 3 pa-
tients (3.8%), and consisted of postoperative bleeding.
Conclusion
Compared to current literature, we demonstrate a higher rate of TEM resections of
giant rectal polyps. In spite of their size, these lesions were successfully removed
with clear margins in the majority of cases. These large polyps also contained a high
percentage of unrecognized malignancies. Overall, TEM has been found to be a safe
alternative to radical surgical excision of giant rectal polyps, with both low complica-
tion and recurrence rates.
23
Early and late continence after bladder neck sparing radical prostatectomy
Chun Huang, Jennifer Bjazevic, Darrel Drachenberg
(Section of Urology, Department of Surgery, University of Manitoba)
Introduction
Urinary incontinence is a well-recognized side effect of radical prostatectomy. It has
been demonstrated that laparoscopic and robotic prostatectomy result in improved
early return to continence with a bladder neck sparing (BNS) technique.
Methods
A retrospective chart review was performed, looking at early and late continence
results of BNS surgery in open radical prostatectomy compared to non-BNS surgery
between April 2013 and Dec 2014. 42 patients have been reviewed and 12 BNS cases
identified. Data reviewed include age, stage, grade of tumour, pathologic stage,
positive margin rate, immediate, early, and late continence, measured by use of
incontinence pads. Tumor pathology and surgical margins were observed and corre-
lated to margin positivity rates.
Results
BNS patients had improved early return to continence at 3 and 6-month follow up
(66% vs. 26%) but no change in over-all continence at 1-year with 75% of BNS pa-
tients achieving one pad or less per day and 80% of the non-BNS patients achieving
similar levels of continence. There were 3 positive margins identified in the BNS
group while 1 positive margin was identified in the non-BNS cohort.
Conclusion
This study demonstrates return to early continence associated with bladder neck
sparing surgery. There does not appear to be a long-term benefit. While there is a
suggested higher rate of positive margins with the BNS approach, other studies have
not shown significant effect of margin positivity on over-all survival in organ-
confined disease. Thus, BNS approach to radical prostatectomy can be considered
for select patients.
24
Comparison of physical fitness between surgical and non-surgical residents
David Perrin1, Dean Cordingley2, Jeff Leiter2
(1Section of Plastic Surgery, Department of Surgery, University of Manitoba,
2Pan Am Clinic)
Introduction
Although every residency program can be physically, emotionally and intellectually
challenging, it is well known that the demands of surgical residency training offer
strenuous working hours, sleep deprivation and poor eating. Given the nature of
surgical residency training, physical deconditioning would be expected to be greater
amongst surgical residents than non-surgical residents. The purpose of this study is
to evaluate and compare physical fitness levels between surgical and non-surgical
residents. The hypothesis is that surgical residents would have inferior physical fit-
ness scores compared to non-surgical residents.
Methods
This was a comparative study. Residents of all programs at the University of Manito-
ba were invited to participate. Participant gender, age, weekly work hours, and year
of residency were obtained. Maximal VO2 testing was used to evaluate aerobic ca-
pacity. Anthropometric and strength testing were performed including BMI, body
composition, resting blood pressure, resting heart rate, grip strength and a sit-up
test. Differences in scores between both groups were evaluated using a t-test. Corre-
lation analysis was used to identify any association between Maximal VO2 scores
and year of residency.
Results
A total of 45 residents volunteered to participate in this study and were grouped
into surgical (n=21) and non-surgical (n=24) groups. Surgical residents demonstrated
longer working hours (p<0.05), lower aerobic fitness levels (p<0.02) and higher BMI
(p<0.02) compared to the non-surgical residents. No additional differences were
found between the groups in other anthropometric or strength measures. No corre-
lation was found between year of residency and aerobic capacity.
Conclusion
Surgical residents have longer working hours, inferior aerobic fitness levels and high-
er BMI compared to non-surgical residents.
25
A randomized clinical trail comparing the breast and abdominal related morbidity of DIEP and DIEA flaps
Blair Peters, Leif Sigurdson, Edward Buchel, Kimberly Dalke
(Section of Plastic Surgery, Department of Surgery, University of Manitoba)
Introduction
The DIEP flap is the current standard of care in abdominal-based breast reconstruc-
tion. The SIEA flap is felt to be an improvement as it does not damage the ab-
dominal wall. The SIEA flap is reported to be a more difficult dissection with smaller
vessels which put the flap at higher risk of complication. Due to this uncertainty, we
aimed to evaluate the abdominal and breast related morbidity associated with DIEP
and SIEA flaps.
Methods
A double blinded, randomized clinical trial is being performed involving breast can-
cer patients undergoing autologous tissue reconstruction. Women are randomized
to either receive the DIEP or SIEA flap procedure. Objective isokinetic abdominal
testing is done pre-operatively and 3, 6 and 12 months post-operatively. A validated
questionnaire is administered pre-operatively and at 3 and 12 months post. Second-
ary outcomes include flap and donor site complications.
Results
109 patients have enrolled in the study. Preliminary analyses shows post-operative
decreases in abdominal strength in both groups at 3 months. This decrease initially
appears larger in the DIEP group and is trending towards significance. There is pre-
liminary evidence that this strength deficit returns to normal at 1 year. There are no
significant differences in all flap and abdominal complications. There is also no differ-
ence in post-operative pain. There are no significant differences in the intra-
operative findings between groups with an adequate SIEA present in over 60% of
patients.
Conclusion
We have gone further than others in determining the risks and benefits of each
procedure. The frequency and size of the SIEA vessels found as well as the absence
of increased complication rates challenge the assumption that the superficial vessels
are too small to support a tissue flap and suggest that more patients are candidates
for the SIEA flap than once thought.
26
Neuro-imaging findings in pediatric sports-related concussions: A clinical study
Thomas Hall4, Jeff Leiter4, Patrick J. McDonald1, Scott Sawyer2,4, Norm Silver2,4, Martin Bunge3,
Marco Essig3, Michael J. Ellis1,4
(1Section of Neurosurgery, Department of Surgery, University of Manitoba; 2Department of Pediatric & Child Health; 3Diagnostic Imaging; 4Pan Am Clinic, Canada North Concussion Network)
Introduction
The objective of this study was to summarize the results of clinical neuroimaging
studies performed in sports-related concussion patients referred to a multi-
disciplinary pediatric concussion program.
Methods
We conducted a retrospective review of medical records and neuroimaging findings
for all patients referred to a multi-disciplinary pediatric concussion program be-
tween September 2013 and July 2014. Inclusion criteria included: 1.) age ≤ 19 years
of age, 2.) physician-diagnosed SRC. All patients underwent evaluation by one neuro-
surgeon. The two outcomes examined in this study were the frequency of neuroim-
aging studies performed in this population, including computerized tomography (CT)
and magnetic resonance (MRI) studies, and the findings of those studies. Clinical
indications for neuroimaging were summarized. This study was approved by the
local institutional ethics review board.
Results
151 patients (mean age=14 years, 59% female) were included this study. Overall,
24% of patients underwent neuroimaging studies of which 78% were normal. 16% of
patients underwent CT imaging which was normal in 79% of cases. Abnormal CT
with mortality post discharge home were (n=699): preoperative cardiac arrest
(OR=2.52, 95% CI [1.53-4.16], p<0.001), preoperative social assistance requirement
(OR=2.22, 95% CI [1.13-4.34], p=0.021), preoperative infection (OR=1.80, 95% CI
[1.18-2.76], p=0.007), diabetes mellitus (OR=1.49, 95% CI [1.12-1.99], p=0.006),
COPD (OR=1.47, 95% CI [1.03-2.11], p=0.036), congestive heart failure (OR=1.41,
95% CI [1.02-1.94], p=0.036), and age (OR=1.02, 95% CI [1.01-1.04], p=0.005 for
each year of age since surgery).
Conclusion
Following cardiac surgery, 8.9% of patients have prLOSICU with reasonable long
term survival rates. Long term mortality is related more to co-morbidities, initial
presentation (eg. preoperative cardiac arrest) and socioeconomic status rather than
having a complex cardiac operation. This information may prove useful in determin-
ing goals of care in “sick” cardiac surgery patients “struggling” in the ICU.
29
Shits happens: Integrated knowledge translation to identify and prioritize knowledge needs faced by Hirschsprung’s Disease families
Kendall Hobbs-Murison1,2,3, M. Morris2,3,8, K. Wittmeier3,7,8, C. Holland1, E. Crawford4, J. Elson5, C. Beauchamp5,
B. Milne5, H. Loewen6, A. Abou-Setta7, R. Keijzer2,3.8
(1Child Health Program, Health Science Centre, 2Department of Surgery, University of Manitoba, 3Children’s Hospital Research Institute of Manitoba, 4Swish Productions Ltd., 5Direct Focus Marketing Communications
Inc., 6NJ Maclean Health Sciences Library and 7Centre for Healthcare Innovation, University of Manitoba)
Introduction
Collaboration between knowledge users and providers is fundamental to integrated
Knowledge Translation (iKT). We hypothesized that iKT can be used to guide re-
search questions in rare diseases. Our primary aim was to use social media to priori-
tize information needs of Hirschsprung’s Disease (HD) families and our secondary
aim to compare congruency between information needs of HD families and pediatric
surgeons.
Methods
Partnering with a parent-created social media campaign (Facebook, Twitter and
blog) titled “Shit Happens,” we surveyed families and patients to prioritize infor-
mation needs. Concurrently, using an online tool we surveyed the Canadian Associa-
tion of Paediatric Surgeons (CAPS) to understand i) the most common problems
encountered in their HD practice, and subsequently ii) what information methods
are used to guide clinical management. Surveys were independently analyzed to
determine themes and to rank priorities. We used a modified Delphi approach to
combine results and achieve consensus on a prioritized list of knowledge needs.
Results
89 HD family participants responded to the survey; 66.3% of these within 7 days.
23.9% of CAPS members responded to the survey. Overlapping priorities included
bowel management issues, treating perineal irritation, recognition and management
of enterocolitis. Discordant priorities between families and surgeons included nutri-
tion/growth and diagnostics. Of 21.1% of CAPS survey respondents; 84% use their
expert opinion to guide management, 81% use collegial expert opinion, 76% indicate
guidance from HD literature, and 54% in the literature related to HD while 32% rely
on practice guidelines.
Conclusion
iKT research combining a parent research partner with social media can identify and
prioritize knowledge needs for families dealing with rare diseases such as HD in an
efficient manner. Results of this study are currently guiding knowledge synthesis and
where sufficient, resource development to assist parents.
30
Mental and physical health outcomes in parents of children with burn injuries as compared to matched controls
Jessica Enns1, J.P. Gawaziuk23, S. Khan4, D. Chateau4, J. Bolton5, J. Sareen5, J. Stone1, M. Doupe4, S. Logsetty2,3
(1BSc Med Program, College of Medicine, University of Manitoba, 2Manitoba Firefighters Burn Unit, 3Department of Surgery, University of Manitoba, 4Manitoba Centre for Health Policy
and 5Department of Psychiatry, University of Manitoba0
Introduction
Pediatric burn-injuries are common and the stress of caring for them can affect care-
giver’s health. The objective of this study was to examine the rates of mental and
physical disorders of parents of burn-injured children (Cases) compared to matched
controls (Controls).
Methods
This population-based study links the Winnipeg Children’s Hospital Pediatric burn
registry with health information at the Manitoba Centre for Health Policy. Pediatric
burn cases were matched 1:5 with control children from the general population
based on age, sex and geographical location. 1029 parental Cases and 4923 Controls
were identified. ICD codes were used to identify diagnoses of common mental and
physical disorders, comparing rates of disease 2 years prior to and 2 years following
the date of burn. The changes in the relative rates of health outcomes (pre-injury to
post-injury) were compared between the cases and the controls. This methodology
is an important strength of this study as this allows for correction of changes in rates
due to aging or other factors.
Results
The prevalence of substance abuse disorder 2 years prior to burn date was 3.0%
among cases rising to 10.4% postburn; in controls this change was from 2.11% to
6.03%. There was an absolute rate increase of 7.38% for cases compared to 3.92%
for the controls (a relative increase of over 20%). Similarly there was an absolute
increase of 3.5% and a relative increase of 36% more fractures in the Cases. There
were no significant differences found in other Axis one mental, or physical disorders.
Conclusion
Increased rates of substance use disorder and fractures in the parents of burn-
injured children compared to the matched controls has important clinical implica-
tions for the care of parents who have a burn-injured child.
31
The impact of lumbar spinal stenosis on lower extremity motor control: A pre-surgical study
Austin Enright, Michael Johnson, Valerie Pelleck, Dean Kriellaars, Cheryl Glazebrook Steven Passmore
(Section of Orthopedic Surgery, Department of Surgery, University of Manitoba)
Introduction
Objective outcome measures are lacking for the progression, impairment and man-
agement of degenerative lumbar spinal stenosis (LSS). The most common reason for
adults over 65 to proceed to spine surgery is LSS. Fitts’ Law is an established motor
paradigm that may provide a novel approach to outcome measurement since task
difficulty is easily manipulated, and performance on Fitts’ Law tasks are resistant to
learning. Hypothesis: We predict that pre-surgical LSS patients will be demonstrate
performance that is more adversely impacted than healthy control participants
when measuring their physical ability to perform a motor task. Study Design: Cross-
sectional between groups experimental design.
Method
Participants with degenerative LSS (N=12) and healthy controls (N=12) performed
pointing movements with their great toe to a series of squares that appeared on a
touchscreen monitor. Three dimensional motion analysis recorded movement. Be-
havioural measures included reaction time and movement time (MT), kinematic
performance measures were also recorded. The Health Research Ethics Board ap-
proved all protocols and procedures.
Results
Significant interactions for MT [F(5,110) = 3.17, p<.05] and kinematic variables time
to peak velocity [F(5,110) = 5.51 p<.05] and peak velocity [F(5,110) = 9.61 p<.05 ]
respectively revealed that the LSS group’s movements were more adversely impact-
ed by increasing task ID.
Conclusion
A lower extremity Fitts’ Law task is useful in measuring differences between healthy
and pre-surgical LSS populations. In the future it may be applied in LSS surgical in-
tervention studies considering motor performance measurement as a quantitative
outcome measure.
32
Non-neoplastic kidney and predictors of post-operative renal insufficiency in radical nephrectomies
Ruchi Chhibba1, Deepak K. Pruthi2, Thomas B. McGregor2
(1UGME-College of Medicine, University of Manitoba,
and 2Section of Urology, Department of Surgery, University of Manitoba)
Introduction
To identify predictors of post-operative renal insufficiency by analyzing clinical co-
morbidities and the pathologic changes in the non-neoplastic kidney (NNK) speci-
mens of patients undergoing radical nephrectomy (RN).
Methods
We retrospectively reviewed all patients undergoing RN for suspected RCC from
January 2011-May 2014. Estimated glomerular filtration rate (eGFR) was calculated
employing the modified diet in renal disease (MDRD) formula using the 6 month
creatinine value. Pathologic reports were reviewed to assess for any glomerular,
tubulointerstitial and arterial/arteriolar (GTA) changes. Univariant analysis was em-
ployed.
Results
Of the 147 patients undergoing RN, 57 (39%) had changes in the NNK, 57 (39%) had
unremarkable changes and 33 (22%) had no specific comments on the NNK. Fourty-
two patients had specific changes to the GTA architecture; of these 42, 51% had
more than one GTA change. Patients with GTA changes were not more likely to have
declines in post-operative (PsO) renal function compared to those with unremarka-
ble findings (p=0.15). However, those with pre-operative (PrO) eGFR > 60/ml/
min/1.73m2 had a greater decrease in PsO renal function than those with PrO eGFR
of <60 (-26 vs -6ml/min/1.73m2, p<0.0001). Overall, patients with GTA changes were
more likely to have a lower PrO eGFR (<60 vs >60 ml/min/1.73m2, p=0.009) than
those with unremarkable changes. Patients with a tumor size < 10 cm had a greater
decrease in PsO renal function compared with a tumor size >10 cm (-25 vs -14 ml/
min/1.73m2, p=0.011). New onset stage 3 CKD or greater occurred in 65% of pa-
tients. Diabetes, hypertension, smoking status, and age (>60) were not statistically
significant in predicting PsO renal function.
Conclusion
Smaller tumor size and higher PrO eGFR were associated with greater decline in PsO
renal function. NNK changes did not predict renal functional outcome in this series.
New CKDIII occurred in over half of all patients.
33
Arthroscopic versus open lateral release for the treatment of lateral epicondylitis; A prospective randomized controlled trial
Jamie Dubberley1, Tod Clark1, Sheila Mcrae2, Jeff Leiter2, Peter MacDonald1
(1Section of Orthopedic Surgery—Pan Am Clinic, Department of Surgery, University of Manitoba;
and 2Pan Am Clinic Foundation)
Introduction
The primary objective of this study was to determine if quality of life and function
are different following arthroscopic versus open tennis elbow release surgery.
Based on retrospective studies, both approaches have been found to be beneficial,
but no prospective randomized comparison has been conducted to date.
Methods
Following a minimum six-months of conservative treatment, seventy-one patients
(>16 yrs old) were randomized intraoperatively to undergo either arthroscopic or
open lateral release. Outcome measures were the Disabilities of the Arm, Shoulder
and Hand questionnaire (DASH), a 5-question VAS Pain Scale, and grip strength.
Study assessments took place pre-, and 6-week, 3-, 6-, and 12-months post-surgery.
Comparisons between groups and within groups over time were conducted with
p<0.05.
Results
No pre-surgery differences were found between groups based on age, sex, DASH or
VAS scores. Fifteen women and 19 men underwent the open procedure with mean
age 47.1 years (6.7) and 13 women and 21 men were in the arthroscopic group with
mean age of 45.0 (6.9). Both groups demonstrated a significant improvement in all
measures following surgery, and no significant differences were found between
groups at any time point. The DASH, our primary outcome, decreased from a mean
(SD) of 47.5 (14.5) pre-surgery to 21.9 (21.8) at 12-months post-surgery in the Open
group and from 52.7 (16.0) to 22.6 (21.1) in the Arthroscopic group. VAS-pain scores
followed a similar pattern. Grip strength increased on the affected side from 23.6
(14.9) kg to 29.3 (16.3) and 21.4 (15.4) kg to 29.8 (15.4) for Open and Arthroscopic
groups, respectively.
Conclusion
Based on this study, there is no difference in patient quality of life and function be-
tween arthroscopic and open tennis elbow release surgery. More detailed analysis
of the impact of third party claims, sex, and smoking status would be beneficial.
34
Participant’s Abstract Index
Aziz, Mina ........................................................................................................................... 27
Barchet, Lyra de Fatima ..................................................................................................... 20
Bjazevic, Jennifer ................................................................................................................ 17
Chernos, Courtney ............................................................................................................. 22